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Nguyen J, Madonia V, Bland CM, Stover KR, Eiland LS, Keating J, Lemmon M, Bookstaver PB, as part of the Southeastern Research Group Endeavor (SERGE‐45) research network. A review of antibiotic safety in pregnancy-2025 update. Pharmacotherapy 2025; 45:227-237. [PMID: 40105039 PMCID: PMC11998890 DOI: 10.1002/phar.70010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 02/11/2025] [Accepted: 02/16/2025] [Indexed: 03/20/2025]
Abstract
Antibiotics constitute the majority of prescriptions for women during pregnancy. Common bacterial infections, including urinary tract infections, skin and soft tissue infections, and upper and lower respiratory tract infections, are expected in pregnancy, similar to the general public. These infections carry additional risks to both the woman and fetus; thus, antibiotics are often prescribed. Antibiotics, like other drugs, are not benign and may carry additional risks to the fetus beyond commonly encountered adverse drug events seen across most patient populations. Since 2014, 19 new antibiotics have been approved by the United States Food and Drug Administration. Additionally, in 2018, the previously held pregnancy category rating expired, and all manufacturers' labeling was updated with new narrative language reflecting safety in pregnancy, lactation, and males and females of reproductive potential. This review provides a comprehensive summary of available data and an update to the 2015 publication regarding the safe use of antibiotics in pregnancy. The primary focus of this review is on newly approved antibiotics, along with any additional published evidence on previously reviewed antibiotics. Data on lactation or antiviral or antifungal use in pregnancy are not included. Clinicians should remain updated on current available evidence and vigilant to provide safe and effective antibiotic decision-making in pregnant women.
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Affiliation(s)
- Johny Nguyen
- University of South Carolina College of PharmacyColumbiaSouth CarolinaUSA
| | - Victoria Madonia
- University of South Carolina College of PharmacyColumbiaSouth CarolinaUSA
| | | | - Kayla R. Stover
- University of Mississippi School of PharmacyJacksonMississippiUSA
| | - Lea S. Eiland
- Auburn University Harrison College of PharmacyAuburnAlabamaUSA
| | - Julia Keating
- University of South Carolina College of PharmacyColumbiaSouth CarolinaUSA
| | - Madeline Lemmon
- University of South Carolina College of PharmacyColumbiaSouth CarolinaUSA
| | - P. Brandon Bookstaver
- University of South Carolina College of PharmacyColumbiaSouth CarolinaUSA
- Prisma Health Richland, Department of PharmacyColumbiaSouth CarolinaUSA
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Burchette JE, Covert K, Tu P, White BP, Chastain DB, Cluck DB. Pivmecillinam for Uncomplicated Acute Cystitis: A Contemporary Review. Ann Pharmacother 2024:10600280241288554. [PMID: 39644108 DOI: 10.1177/10600280241288554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2024] Open
Abstract
OBJECTIVE To review the evidence and discuss use of pivmecillinam in uncomplicated acute cystitis. DATA SOURCES A literature search was conducted utilizing PubMed (from 2000 through August 2024) and ClinicalTrials.gov. Medical Subject Headings (MeSH) terms, such as mecillinam or pivmecillinam and urinary tract infections, were utilized. Additional references were identified by reviewing literature citations. STUDY SELECTION AND DATA EXTRACTION Articles were limited to English language publications evaluating the efficacy or safety of pivmecillinam for urinary tract infections (UTIs) in adult populations. DATA SYNTHESIS Data from 6 randomized controlled trials support pivmecillinam for acute uncomplicated cystitis at doses of 200 to 400 mg 3 times daily for 3 to 7 days, with more consistent clinical and bacteriologic cure observed with 400 mg doses and longer therapy durations. Clinical evaluation of 400 mg 2 to 3 times daily is available with use more common in non-US Food and Drug Administration (FDA)-approved populations, such as men, pregnancy, and multidrug resistant infections. There are limited data supporting pivmecillinam for pyelonephritis; routine use is cautioned until further clinical data are available. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS As resistance to first-line antimicrobials rises, the need for safe and effective treatment options remains high. Pivmecillinam represents a new therapeutic option available in the United States for outpatient management of uncomplicated acute cystitis. CONCLUSION Pivmecillinam could be a key agent for uncomplicated acute cystitis. Utilization will likely be cost driven, but the promise of low resistance encourages the place in therapy when other agents are not susceptible to infecting uropathogens.
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Affiliation(s)
- Jessica E Burchette
- Department of Pharmacy Practice, ETSU Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
| | - Kelly Covert
- Department of Pharmacy Practice, ETSU Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
| | - Patrick Tu
- Department of Pharmacy Services, Charlie Norwood Department of Veterans Affairs Medical Center, VA Augusta Health Care, Augusta, GA, USA
| | - Bryan P White
- University of Oklahoma Medical Center, Oklahoma City, OK, USA
| | | | - David B Cluck
- Department of Pharmacy Practice, ETSU Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
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Cullinan L, Dunn L, McLean S, Palombo E. Waterborne disease outbreaks in treated recreational water facilities: a Socio-Ecological Model perspective. Health Promot Int 2022; 37:6646638. [PMID: 35853153 DOI: 10.1093/heapro/daac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treated recreational water facilities, including swimming pools and water play parks, have often been implicated in infectious disease outbreaks. Addressing this problem is complex due to the multiple and interrelated factors contributing to outbreaks in these settings. These factors may relate to inappropriate behaviours of users and operators, lack of and inconsistent regulation of these facilities, insufficient facility maintenance, and problems associated with the design of these facilities. Given the complexity of this issue, we argue that the Socio-Ecological Model (SEM) provides a useful framework to help identify the multi-level influences and factors that have implications for designing interventions to prevent this public health problem, whilst assisting in guiding future research in this area. We apply the SEM to the current literature to help identify the influences and factors contributing to infectious disease outbreaks in treated recreational water facilities to support this argument. We also identify several gaps in the existing research that would benefit from further examination to help prevent infectious disease outbreaks in treated recreational water facilities such as public swimming pools and water play parks.
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Affiliation(s)
- Lauren Cullinan
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Louise Dunn
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Sarah McLean
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Enzo Palombo
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
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Lebbad M, Winiecka-Krusnell J, Stensvold CR, Beser J. High Diversity of Cryptosporidium Species and Subtypes Identified in Cryptosporidiosis Acquired in Sweden and Abroad. Pathogens 2021; 10:pathogens10050523. [PMID: 33926039 PMCID: PMC8147002 DOI: 10.3390/pathogens10050523] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
The intestinal protozoan parasite Cryptosporidium is an important cause of diarrheal disease worldwide. The aim of this study was to expand the knowledge on the molecular epidemiology of human cryptosporidiosis in Sweden to better understand transmission patterns and potential zoonotic sources. Cryptosporidium-positive fecal samples were collected between January 2013 and December 2014 from 12 regional clinical microbiology laboratories in Sweden. Species and subtype determination was achieved using small subunit ribosomal RNA and 60 kDa glycoprotein gene analysis. Samples were available for 398 patients, of whom 250 (63%) and 138 (35%) had acquired the infection in Sweden and abroad, respectively. Species identification was successful for 95% (379/398) of the samples, revealing 12 species/genotypes: Cryptosporidium parvum (n = 299), C. hominis (n = 49), C. meleagridis (n = 8), C. cuniculus (n = 5), Cryptosporidium chipmunk genotype I (n = 5), C. felis (n = 4), C. erinacei (n = 2), C. ubiquitum (n = 2), and one each of C. suis, C. viatorum, C. ditrichi, and Cryptosporidium horse genotype. One patient was co-infected with C. parvum and C. hominis. Subtyping was successful for all species/genotypes, except for C. ditrichi, and revealed large diversity, with 29 subtype families (including 4 novel ones: C. parvum IIr, IIs, IIt, and Cryptosporidium horse genotype Vic) and 81 different subtypes. The most common subtype families were IIa (n = 164) and IId (n = 118) for C. parvum and Ib (n = 26) and Ia (n = 12) for C. hominis. Infections caused by the zoonotic C. parvum subtype families IIa and IId dominated both in patients infected in Sweden and abroad, while most C. hominis cases were travel-related. Infections caused by non-hominis and non-parvum species were quite common (8%) and equally represented in cases infected in Sweden and abroad.
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Affiliation(s)
- Marianne Lebbad
- Department of Microbiology, Public Health Agency of Sweden, 171 82 Solna, Sweden; (M.L.); (J.W.-K.)
| | | | - Christen Rune Stensvold
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, DK-2300 Copenhagen S, Denmark;
| | - Jessica Beser
- Department of Microbiology, Public Health Agency of Sweden, 171 82 Solna, Sweden; (M.L.); (J.W.-K.)
- Correspondence:
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Cullinan L, McLean S, Dunn L. Preventing and controlling Cryptosporidium spp. in aquatic facilities: environmental health practitioners' experiences in Victoria, Australia. Aust N Z J Public Health 2020; 44:233-239. [PMID: 32459385 DOI: 10.1111/1753-6405.12984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To identify barriers and enablers to preventing and controlling Cryptosporidium spp. in aquatic facilities as perceived by environmental health practitioners (EHPs). METHODS A qualitative, constructivist study with a purposive sample of seven EHPs from Victoria, Australia, was conducted. A focus group discussion was guided by a semi-structured interview schedule using open-ended questions. The audio-recorded focus group was transcribed verbatim and analysed using thematic analysis. RESULTS Five themes represented the perceived barriers and enablers: i) pool water testing methods; ii) resources and training for EHPs; iii) knowledge and behaviour of aquatic facility operators and swimming pool users; iv) regulation; and v) aquatic facility and swimming pool design. Two key barriers within these themes included aquatic facility regulation and unhealthy swimming behaviours. CONCLUSIONS Several barriers and enablers to preventing and controlling Cryptosporidium spp. in aquatic facilities were perceived by EHPs. Suggestions to overcome perceived barriers were also identified. Further research is required to determine the impact of these findings on the incidence of cryptosporidiosis associated with aquatic facilities. Implications for public health: The findings contribute to a greater understanding of the barriers and enablers to Cryptosporidium spp. prevention and control in aquatic facilities, which may improve the effectiveness of current prevention and control strategies.
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Affiliation(s)
- Lauren Cullinan
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Victoria
| | - Sarah McLean
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Victoria
| | - Louise Dunn
- Department of Chemistry and Biotechnology, Swinburne University of Technology, Victoria
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6
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Nic Lochlainn LM, Sane J, Schimmer B, Mooij S, Roelfsema J, van Pelt W, Kortbeek T. Risk Factors for Sporadic Cryptosporidiosis in the Netherlands: Analysis of a 3-Year Population Based Case-Control Study Coupled With Genotyping, 2013-2016. J Infect Dis 2020; 219:1121-1129. [PMID: 30395258 PMCID: PMC6420163 DOI: 10.1093/infdis/jiy634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/01/2018] [Indexed: 11/14/2022] Open
Abstract
Background In 2012, cryptosporidiosis cases increased in the Netherlands, but no single source was identified. In April 2013, we began a 3-year population-based case-control study coupled with genotyping to identify risk factors for sporadic cryptosporidiosis. Methods Cryptosporidium cases were laboratory confirmed (by microscopy or polymerase chain reaction), and the species (ie, C. hominis or C. parvum) was determined. We analyzed data by study year, combined and by species. We performed single-variable analysis, and variables with a P value of ≤ .10 were included in a multivariable logistic regression model adjusting for age, sex, and season. Results The study included 609 cases and 1548 frequency-matched controls. C. parvum was the predominant species in the first 2 study years, shifting to C. hominis in the third year. Household person-to-person transmission and eating barbequed food were strongly associated with being a case. Eating tomatoes was negatively associated. When the analysis was stratified by study year, person-to-person transmission was an independent risk factor. Analysis by species identified different risk factors for cases infected with C. parvum and C. hominis. Conclusion This was the first case-control study examining risk factors for sporadic cryptosporidiosis in the Netherlands. Providing information about Cryptosporidium exposure during outdoor activities and improvements in hygiene within households could prevent future sporadic infections.
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Affiliation(s)
- Laura M Nic Lochlainn
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,European Program for Intervention Epidemiology Training, European Center for Disease Prevention and Control, Stockholm, Sweden
| | - Jussi Sane
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.,European Program for Intervention Epidemiology Training, European Center for Disease Prevention and Control, Stockholm, Sweden
| | - Barbara Schimmer
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Sofie Mooij
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jeroen Roelfsema
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Wilfrid van Pelt
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Titia Kortbeek
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Mavridou A, Pappa O, Papatzitze O, Dioli C, Kefala AM, Drossos P, Beloukas A. Exotic Tourist Destinations and Transmission of Infections by Swimming Pools and Hot Springs-A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2730. [PMID: 30513967 PMCID: PMC6313699 DOI: 10.3390/ijerph15122730] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/18/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023]
Abstract
A growing number of people undertake international travel, and yet faster growth of such travel is expected in the tropics. Information on the hazards presented by pool and hot spring waters in tropical countries is very limited. This review aims to collate available information on pool water quality, alongside data on cases and outbreaks associated with swimming in pools in tropical regions affecting both local populations and travellers. Bacteria species commonly causing cases and outbreaks in the tropics as well as elsewhere in the world were excluded, and the review focuses on studies related to pathogens that, with the exception of Cryptosporidium, are unusual in more temperate climates. Studies concerning subtropical countries were included in the light of climate change. Diseases transmitted by vectors breeding in poorly maintained, neglected or abandoned pools were also included. 83 studies dealing with Microsporidia, Leptospira spp., Schistosomas spp., Cryptosporidium spp., Acanthamoeba spp., Naegleria spp., Clostridium trachomatis, viruses, and vectors breeding in swimming pool and hot tub waters, and fulfilling predefined criteria, have been included in our survey of the literature. In conclusion, prevention strategies for pool safety in the tropics are imperative. Public health authorities need to provide guidance to westerners travelling to exotic destinations on how to protect their health in swimming pools.
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Affiliation(s)
- Athena Mavridou
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece.
| | - Olga Pappa
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece.
- Central Public Health Laboratory, Hellenic Centre of Disease Control and Prevention, 15123 Maroussi, Greece.
| | - Olga Papatzitze
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece.
- West Attica General Hospital, "Santa Barbara", 12351 Santa Barbara, Greece.
| | - Chrysa Dioli
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece.
| | | | - Panagiotis Drossos
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece.
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece.
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK.
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Gracenea M, Castaño S, Méndez J, Lucena F, Gómez MS. Faecal contamination in public pools in Barcelona province: Cryptosporidium spp. and bacterial indicators. JOURNAL OF WATER AND HEALTH 2018; 16:762-772. [PMID: 30285957 DOI: 10.2166/wh.2018.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A study was conducted of the occurrence of Cryptosporidium in indoor heated public swimming pools and of three bacterial indicators (Escherichia coli, faecal enterococci and Clostridium perfringens) on pool surrounds. Although all examined pools adhered strictly to the Spanish regulations, the influence of several parameters related to water conditions, pool structure, users and location on the presence of protozoa and bacteria was analysed. Cryptosporidium was detected in 18.8% of pools in 60% of the five towns studied. The maximum concentration was 13 oocysts/L in one swimming pool and one Jacuzzi. The bacterial indicators' prevalence on pool surrounds was higher than 50%, being present in all of the towns. Plastic surfaces presented the lowest bacterial prevalence, whereas painted surfaces were 100% positive. No differences were observed for pool surrounds with autonomous or disabled users. Risk of cryptosporidiosis in pool vessels indicated that concentrations over 1 oocyst/10 L enhance the risk of infection, even in one exposure. Guidelines for managing faecal accidents and public information on the importance of good hygiene behaviours in and around swimming pools are recommended to limit oocysts' presence.
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Affiliation(s)
- M Gracenea
- Section of Parasitology, Department of Biology, Healthcare and the Environment, Faculty of Pharmacy and Food Sciences, University of Barcelona, Av. Joan XXIII s/n, Barcelona, Spain
| | - S Castaño
- Section of Parasitology, Department of Biology, Healthcare and the Environment, Faculty of Pharmacy and Food Sciences, University of Barcelona, Av. Joan XXIII s/n, Barcelona, Spain
| | - J Méndez
- Section of Microbiology, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Av. Diagonal 643, Barcelona, Spain E-mail:
| | - F Lucena
- Section of Microbiology, Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Av. Diagonal 643, Barcelona, Spain E-mail:
| | - M S Gómez
- Section of Parasitology, Department of Biology, Healthcare and the Environment, Faculty of Pharmacy and Food Sciences, University of Barcelona, Av. Joan XXIII s/n, Barcelona, Spain
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Alsmark C, Nolskog P, Angervall AL, Toepfer M, Winiecka-Krusnell J, Bouwmeester J, Bjelkmar P, Troell K, Lahti E, Beser J. Two outbreaks of cryptosporidiosis associated with cattle spring pasture events. VETERINARY PARASITOLOGY- REGIONAL STUDIES AND REPORTS 2018; 14:71-74. [PMID: 31014741 DOI: 10.1016/j.vprsr.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/29/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022]
Abstract
Over a period of less than four weeks, 50 human cases of cryptosporidiosis were reported from a relatively small geographical area in Sweden. All cases were associated with visits to cattle spring pasture events at two farms (referred to as Farm A and B). Epidemiological and microbiological evidence show that contact with calves at the farms was the most likely source of Cryptosporidium infections. Gp60 sequences from human and calf isolates at Farm A were identical to each other, but differed from those at Farm B where, again, human and calf gp60 sequences were identical, proving that the two outbreaks had no common origin. As a direct consequence of these two outbreaks, and guided by knowledge gained from the outbreak investigations, the Swedish Board of Agriculture and all relevant farmer advisory organizations have updated their hygiene instructions for farm visits.
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Affiliation(s)
- Cecilia Alsmark
- National Veterinary Institute, Uppsala, Sweden; Uppsala University, Uppsala, Sweden.
| | - Peter Nolskog
- Department of Communicable Disease Control and Prevention of Region Västra Götaland, Sweden
| | | | | | | | | | | | | | - Elina Lahti
- National Veterinary Institute, Uppsala, Sweden
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Adeyemo FE, Singh G, Reddy P, Stenström TA. Methods for the detection of Cryptosporidium and Giardia: From microscopy to nucleic acid based tools in clinical and environmental regimes. Acta Trop 2018; 184:15-28. [PMID: 29395034 DOI: 10.1016/j.actatropica.2018.01.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 12/21/2017] [Accepted: 01/22/2018] [Indexed: 01/18/2023]
Abstract
The detection and characterization of genotypes and sub genotypes of Cryptosporidium and Giardia is essential for their enumeration, surveillance, prevention, and control. Different diagnostic methods are available for the analysis of Cryptosporidium and Giardia including conventional phenotypic tools that face major limitations in the specific diagnosis of these protozoan parasites. The substantial advancement in the development of genetic signature based molecular tools for the quantification, diagnosis and genetic variation analysis has increased the understanding of the epidemiology and preventive measures of related infections. The conventional methods such as microscopy, antibody and enzyme based approaches, offer better detection results when combined with advanced molecular methods. Gene based approaches increase the precision of identification, for example, many signatures detected in environmental matrices represent species/genotype that are not infectious to humans. This review summarizes the available methods and the advantages and limitations of advance detection techniques like nucleic acid-based approaches for the detection of viable oocysts and cysts of Cryptosporidium and Giardia along with the conventional and widely accepted detection techniques like microscopy, antibody and enzyme based ones. This technical article also encourages the wide application of molecular methods in genetic characterization of distinct species of Cryptosporidium and Giardia, to adopt necessary preventive measures with reliable identification and mapping the source of contamination.
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Affiliation(s)
- Folasade Esther Adeyemo
- SARChI Chair, Institute for Water and Wastewater Technology (IWWT), Durban University of Technology, P.O. Box 1334, Durban, 4000, South Africa
| | - Gulshan Singh
- SARChI Chair, Institute for Water and Wastewater Technology (IWWT), Durban University of Technology, P.O. Box 1334, Durban, 4000, South Africa.
| | - Poovendhree Reddy
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, P.O. Box 1334, Durban, 4000, South Africa
| | - Thor Axel Stenström
- SARChI Chair, Institute for Water and Wastewater Technology (IWWT), Durban University of Technology, P.O. Box 1334, Durban, 4000, South Africa
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ElBakri A, Mogane L, Ezzedine S, Potgieter N, Bessong P, AbuOdeh R, Samie A. PREVALENCE OF CRYPTOSPORIDIUM SPP. AMONG ASYMPTOMATIC HEALTHY EXPATRIATE WORKERS IN SHARJAH, UNITED ARAB EMIRATES. Afr J Infect Dis 2018; 12:7-13. [PMID: 30109280 PMCID: PMC6085736 DOI: 10.21010/ajid.v12i2.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background: Epidemiological data on Cryptosporidium infections in the United Arab Emirates (UAE) is scarce. Therefore, the main objective of this study was to determine the prevalence of Cryptosporidium species among a community of expatriates in Sharjah, UAE working in different sectors, including the food industry, house maids and other domestic occupations. Materials and Methods: One hundred and thirty four stool samples were collected from asymptomatic individuals presenting to the Sharjah Municipality Public Health Clinic (SMPHC) for screening of intestinal parasites for work permission purposes between 2009 and 2011. Demographic information such as age, sex, and country of origin was collected. Genomic DNA extracted from the stool samples were tested for Cryptosporidium species using real-time PCR (qPCR). Results: Twenty-six individuals (19.4%) were positive for Cryptosporidium sp. by PCR. The infection rate was found to be highest in Afghan nationals (33%; 3/9) compared with the rest of the study population; yet, no significant association existed between nationality and infection rate. Moreover, no association was observed between infection rate and gender (χ2 = 2.439; P = 0.118), nor infection rate and age group (χ2 = 1.219; P = 0.544). Conclusion: Infection by Cryptosporidium sp. was common in the study group, and further studies are needed within the native Emirati population before any conclusions can be made about foreigners potentially transmitting the parasite. Furthermore, data provided in this study could help determine its public and veterinary significance particularly in outbreaks in the country.
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Affiliation(s)
- Ali ElBakri
- Medical Laboratory Sciences Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Lazarus Mogane
- University of Venda, Department of Microbiology, Thohoyandou, South Africa
| | - Sinda Ezzedine
- Medical Laboratory Sciences Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Natasha Potgieter
- University of Venda, Department of Microbiology, Thohoyandou, South Africa
| | - Pascal Bessong
- HIV/AIDS and Global Health Research Programme, Department of Microbiology, University of Venda, Thohoyandou, South Africa
| | - Raed AbuOdeh
- Medical Laboratory Sciences Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Amidou Samie
- University of Venda, Department of Microbiology, Thohoyandou, South Africa
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12
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Daniels ME, Smith WA, Jenkins MW. Estimating Cryptosporidium and Giardia disease burdens for children drinking untreated groundwater in a rural population in India. PLoS Negl Trop Dis 2018; 12:e0006231. [PMID: 29377884 PMCID: PMC5805363 DOI: 10.1371/journal.pntd.0006231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/08/2018] [Accepted: 01/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background In many low-income settings, despite improvements in sanitation and hygiene, groundwater sources used for drinking may be contaminated with enteric pathogens such as Cryptosporidium and Giardia, which remain important causes of childhood morbidity. In this study, we examined the contribution of diarrhea caused by Cryptosporidium and Giardia found in groundwater sources used for drinking to the total burden of diarrheal disease among children < 5 in rural India. Methodology/Principal findings We studied a population of 3,385 children < 5 years of age in 100 communities of Puri District, Odisha, India. We developed a coupled quantitative microbial risk assessment (QMRA) and susceptible-infected-recovered (SIR) population model based on observed levels of Cryptosporidium and Giardia in improved groundwater sources used for drinking and compared the QMRA-SIR estimates with independently measured all-cause (i.e., all fecal-oral enteric pathogens and exposure pathways) child diarrhea prevalence rates observed in the study population during two monsoon seasons (2012 and 2013). We used site specific and regional studies to inform assumptions about the human pathogenicity of the Cryptosporidium and Giardia species present in local groundwater. In all three human pathogenicity scenarios evaluated, the mean daily risk of Cryptosporidium or Giardia infection (0.06–1.53%), far exceeded the tolerable daily risk of infection from drinking water in the US (< 0.0001%). Depending on which protozoa species were present, median estimates of daily child diarrhea prevalence due to either Cryptosporidium or Giardia infection from drinking water was as high as 6.5% or as low as < 1% and accounted for at least 2.9% and as much as 65.8% of the all-cause diarrhea disease burden measured in children < 5 during the study period. Cryptosporidium tended to account for a greater share of estimated waterborne protozoa infections causing diarrhea than did Giardia. Diarrhea prevalence estimates for waterborne Cryptosporidium infection appeared to be most sensitive to assumptions about the probability of infection from ingesting a single parasite (i.e. the rate parameter in dose-response model), while Giardia infection was most sensitive to assumptions about the viability of parasites detected in groundwater samples. Conclusions/Significance Protozoa in groundwater drinking sources in rural India, even at low concentrations, especially for Cryptosporidium, may account for a significant portion of child diarrhea morbidity in settings were tubewells are used for drinking water and should be more systematically monitored. Preventing diarrheal disease burdens in Puri District and similar settings will benefit from ensuring water is microbiologically safe for consumption and consistent and effective household water treatment is practiced. Water, sanitation, and hygiene (WASH) interventions aimed at reducing exposure to enteric pathogens have produced mixed health impacts, with some interventions finding no significant difference in health outcomes between intervention and control groups. While there are many explanations why individual WASH interventions may not achieve improved health outcomes, one reason is an incomplete understanding of the conditions that favor perpetuation and transmission of enteric pathogens in a given population and region. In this study, we developed a set of diarrhea-causing disease transmission models using measurements of drinking water contamination and child diarrhea over the same time period in the same study population. Using the disease transmission models, we examined how much of the observed diarrhea in children was due to waterborne transmission of enteric pathogens in a program in rural India that improved household sanitation but failed to produce improvements in child health. We focused on the role of two enteric protozoal pathogens, Cryptosporidium and Giardia, and diarrhea rates among children < 5 years of age in these communities. We found that Cryptosporidium and Giardia infections from drinking water contaminated with these enteric protozoa may have together caused as much as 65.8% (IQR 63.4–68.2%) or as little as 2.9% (IQR 2.3–3.4%) of the observed diarrhea in children depending on modeling assumptions about which protozoa species were present. These findings suggest implementing a single barrier, such as only sanitation, to disrupt the multiple pathways of fecal-oral transmission of enteric pathogens, rather than multiple barriers, such as sanitation and safe drinking water, may lead some interventions to fall short of achieving measurable health improvements. Finally, our research suggests that Cryptosporidium and Giardia may cause significant amounts of child diarrhea morbidity even at low levels of concentration when present in improved drinking water sources and their measurement should be including in community drinking water quality monitoring programs.
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Affiliation(s)
- Miles E. Daniels
- Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California at Davis, Davis, California United States of America
- Department of Institute of Marine Sciences, University of California at Santa Cruz, Santa Cruz, California, United States of America, Affiliated with: Fisheries Ecology Division, Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Santa Cruz, California, United States of America
- * E-mail:
| | - Woutrina A. Smith
- Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California at Davis, Davis, California United States of America
| | - Marion W. Jenkins
- Department of Civil and Environmental Engineering, University of California at Davis, Davis, California, United States of America
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Fallahi S, Moosavi SF, Karimi A, Chegeni AS, Saki M, Namdari P, Rashno MM, Varzi AM, Tarrahi MJ, Almasian M. An advanced uracil DNA glycosylase-supplemented loop-mediated isothermal amplification (UDG-LAMP) technique used in the sensitive and specific detection of Cryptosporidium parvum, Cryptosporidium hominis, and Cryptosporidium meleagridis in AIDS patients. Diagn Microbiol Infect Dis 2017; 91:6-12. [PMID: 29366630 DOI: 10.1016/j.diagmicrobio.2017.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 11/18/2022]
Abstract
The rapid and accurate detection of Cryptosporidium spp. is critically important for the prevention and timely treatment of cryptosporidiosis in AIDS patients (APs). This study was conducted to examine a UDG-LAMP technique for the first time to diagnose cryptosporidiosis in APs. After collecting demographic and clinical data, three stool samples were collected from the participants (120 volunteering APs). The microscopic examination of stained smears using the acid-fast method and the UDG-LAMP assay were performed for each sample. 10% of APs were infected with Cryptosporidium spp. The number of detected cryptosporidiosis cases using the acid-fast staining and UDG-LAMP methods were significantly different (P < 0.001). Diarrhea and weight loss were found to be significantly associated with cryptosporidiosis in patients (P < 0.05). The pretreatment of LAMP reagents with UDG successfully eliminated the likelihood of product re-amplification remaining from previous reactions. The UDG-LAMP technique could detect cryptosporidiosis in APs with high sensitivity and rapidity without carryover contamination.
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Affiliation(s)
- Shirzad Fallahi
- Razi Herbal Medicine Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran; Department of Medical Parasitology and Mycology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Seyedeh Fatemeh Moosavi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Azadeh Karimi
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Sharafi Chegeni
- Department of Communicable Disease Control and Prevention, Deputy of Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Saki
- Department of Communicable Disease Control and Prevention, Deputy of Health, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Parsa Namdari
- Medical Student, Faculty of Medicine, University of Debrecen, Hungary
| | | | - Ali Mohamad Varzi
- Department of Immunology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Javad Tarrahi
- Department of Epidemiology and Statistics, Behavioral Sciences Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Mohammad Almasian
- School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Beser J, Hallström BM, Advani A, Andersson S, Östlund G, Winiecka-Krusnell J, Lebbad M, Alm E, Troell K, Arrighi RBG. Improving the genotyping resolution of Cryptosporidium hominis subtype IbA10G2 using one step PCR-based amplicon sequencing. INFECTION GENETICS AND EVOLUTION 2017; 55:297-304. [PMID: 28919550 DOI: 10.1016/j.meegid.2017.08.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/16/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
Cryptosporidium hominis gp60 subtype IbA10G2 is a common cause of cryptosporidiosis. This subtype is responsible for many waterborne outbreaks as well as sporadic cases and is considered virulent and highly important in the epidemiology of cryptosporidiosis. Due to low heterogeneity within the genome of C. hominis it has been difficult to identify epidemiological markers with higher resolution than gp60. However, new markers are required in order to improve outbreak investigations and studies of the transmission dynamics of this clinically important subtype. Based on the whole genome sequences of 17 C. hominis isolates, we have identified several differential loci and developed a new sequence based typing panel with higher resolution than gp60. An amplicon sequencing method was also developed which is based on a one-step PCR which can be sequenced using a Next Generation Sequencing (NGS) platform. Such a system provides a rapid and high-throughput workflow. A panel of nine loci with 10 single nucleotide variants (SNV) was selected and evaluated using clinical IbA10G2 isolates from sporadic, cluster and outbreak associated cases. The specimens were separated into 10 different genetic profiles named sequence types (STs). All isolates within an outbreak or cluster belonged to the same ST, including several samples from the two large waterborne outbreaks which occurred in Sweden between 2010 and 2011 indicating that these outbreaks might be linked. The results demonstrate the methods suitability for improved genotyping of C. hominis IbA10G2.
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Affiliation(s)
| | | | | | | | | | | | | | - Erik Alm
- Public Health Agency of Sweden, Solna, Sweden
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15
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Symptoms and risk factors of Cryptosporidium hominis infection in children: data from a large waterborne outbreak in Sweden. Parasitol Res 2017; 116:2613-2618. [PMID: 28776228 PMCID: PMC5599474 DOI: 10.1007/s00436-017-5558-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/10/2017] [Indexed: 12/24/2022]
Abstract
Cryptosporidium is a major cause of diarrheal disease worldwide. In developing countries, this infection is endemic and in children, associated with growth faltering and cognitive function deficits, with the most severe impact on those aged <2 years. Little has been reported about symptoms and risk factors for children in industrialized countries, although the disease incidence is increasing in such regions. In November 2010, a large waterborne outbreak of C. hominis occurred in the city of Östersund in Sweden. Approximately 27,000 of the 60,000 inhabitants were symptomatic. We aimed to describe duration of symptoms and the risk factors for infection with C. hominis in children aged <15 years in a Western setting. Within 2 months after a boil water advisory, a questionnaire was sent to randomly selected inhabitants of all ages, including 753 children aged <15 years. Those with ≥3 loose stools/day were defined as cases of diarrhoea. The response rate was 70.3%, and 211 children (39.9%) fulfilled the case definition. Mean duration of diarrhoea was 7.5 days (median 6, range 1-80 days). Recurrence, defined as a new episode of diarrhoea after ≥2 days of normal stools, occurred in 52.5% of the cases. Significant risk factors for infection, besides living within the distribution area of the contaminated water plant, included a high level of water consumption, male sex, and a previous history of loose stools. The outbreak was characterized by high attack and recurrence rates, emphasizing the necessity of water surveillance to prevent future outbreaks.
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16
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Boughattas S, Behnke JM, Al-Ansari K, Sharma A, Abu-Alainin W, Al-Thani A, Abu-Madi MA. Molecular Analysis of the Enteric Protozoa Associated with Acute Diarrhea in Hospitalized Children. Front Cell Infect Microbiol 2017; 7:343. [PMID: 28824878 PMCID: PMC5539595 DOI: 10.3389/fcimb.2017.00343] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/14/2017] [Indexed: 12/16/2022] Open
Abstract
Pediatric diarrhea is a common cause of death among children under 5 years of age. In the current study, we investigated the frequency of intestinal parasites among 580 pediatric patients with chronic diarrhea. Parasitic protozoa (all species combined) were detected by molecular tools in 22.9% of the children and the most common parasite was Cryptosporidium spp. (15.1%). Blastocystis hominis was detected in 4.7%, Dientamoeba fragilis in 4%, Giardia duodenalis in 1.7%, and Entamoeba histolytica in 0.17%. Protozoan infections were observed among all regional groups, but prevalence was highest among Qatari subjects and during the winter season. Typing of Cryptosporidium spp. revealed a predominance of Cryptosporidium parvum in 92% of cases with mostly the IIdA20G1 subtype. Subtypes IIdA19G2, IIdA18G2, IIdA18G1, IIdA17G1, IIdA16G1, and IIdA14G1 were also detected. For Cryptosporidium hominis, IbA10G2 and IbA9G3 subtypes were identified. This study provides supplementary information for implementing prevention and control strategies to reduce the burden of these pediatric protozoan infections. Further analyses are required to better understand the local epidemiology and transmission of Cryptosporidium spp. in Qatar.
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Affiliation(s)
- Sonia Boughattas
- Department of Biomedical Science, College of Health Sciences, Biomedical Research Center, Qatar UniversityDoha, Qatar
| | - Jerzy M Behnke
- School of Life Sciences, University of Nottingham, University ParkNottingham, United Kingdom
| | - Khalid Al-Ansari
- Hamad Medical Corporation, Paediatric Emergency CenterDoha, Qatar
| | - Aarti Sharma
- Department of Biomedical Science, College of Health Sciences, Biomedical Research Center, Qatar UniversityDoha, Qatar
| | - Wafa Abu-Alainin
- Molecular Genetics Laboratory, Department of Laboratory Medicine and Pathology, Hamad Medical CorporationDoha, Qatar
| | - Asma Al-Thani
- Department of Biomedical Science, College of Health Sciences, Biomedical Research Center, Qatar UniversityDoha, Qatar
| | - Marawan A Abu-Madi
- Department of Biomedical Science, College of Health Sciences, Biomedical Research Center, Qatar UniversityDoha, Qatar
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17
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Ryan U, Lawler S, Reid S. Limiting swimming pool outbreaks of cryptosporidiosis - the roles of regulations, staff, patrons and research. JOURNAL OF WATER AND HEALTH 2017; 15:1-16. [PMID: 28151435 DOI: 10.2166/wh.2016.160] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cryptosporidium is the leading cause of swimming pool outbreaks of gastroenteritis. Transmission occurs through the ingestion of oocysts that are passed in the faeces of an infected person or animal when an accidental faecal release event occurs. Cryptosporidium parasites present specific challenges for infection control as oocysts are highly resistant to chlorine levels used for pool disinfection, infected individuals can shed large numbers of oocysts, there is a long incubation period and shedding of oocysts occurs even after symptom resolution. The purposes of this review are to identify key barriers to limiting swimming pool-associated outbreaks of cryptosporidiosis and to outline needs for research and collaboration to advance co-ordinated management practices. We reviewed swimming pool-associated cryptosporidiosis outbreaks, disinfection teachniques, current regulations and the role of staff and patrons. Key barriers to limiting swimming pool-associated outbreaks of cryptosporidiosis are a lack of uniform national and international standards, poor adherence and understanding of regulations governing staff and patron behaviour, and low levels of public knowledge and awareness.
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Affiliation(s)
- Una Ryan
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia E-mail:
| | - Sheleigh Lawler
- The University of Queensland, School of Public Health, Herston, Queensland 4006, Australia
| | - Simon Reid
- The University of Queensland, School of Public Health, Herston, Queensland 4006, Australia
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18
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Human cryptosporidiosis in Iran: a systematic review and meta-analysis. Parasitol Res 2017; 116:1111-1128. [PMID: 28110441 DOI: 10.1007/s00436-017-5376-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/12/2017] [Indexed: 01/20/2023]
Abstract
Cryptosporidiosis caused by Cryptosporidium spp. is an important parasitic disease that can be life-threatening for children and immunocompromised patients. This systematic review and meta-analysis was designed to determine the prevalence rate of Cryptosporidium infection and related risk factors among the Iranian general population. We searched electronic databases including Google Scholar, PubMed, Science Direct, Scopus and Proquest for articles in English and SID, Magiran, IranMedex, and IranDoc for articles in Persian. Out of 4816 studies identified in the electronic search, 94 articles were eligible for inclusion in the systematic review and meta-analysis. The prevalence rate of cryptosporidiosis by using the random effect model among children, healthy people, and gastroenteritis and immunocompromised patients in Iran was estimated as 3.65, 2.94, 1.29, and 4.54%, respectively. Findings of a phylogenetic analysis inferred by gp60 and 18S ribosomal RNA markers indicated that most of the infection rate belonged to C. parvum (particularly subtype IIaA15G2R1) and C. hominis among understudied groups. The present study is the first systematic review and meta-analysis providing a comprehensive view of the prevalence of human cryptosporidiosis and its related risk factors in Iran. It seems that the awareness of Cryptosporidium prevalence, risk factors, and disease complications may be required for developing effective strategies to prevent infection.
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19
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Florescu DF, Sandkovsky U. Cryptosporidium infection in solid organ transplantation. World J Transplant 2016; 6:460-471. [PMID: 27683627 PMCID: PMC5036118 DOI: 10.5500/wjt.v6.i3.460] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/22/2016] [Accepted: 06/16/2016] [Indexed: 02/05/2023] Open
Abstract
Diarrhea is a common complication in solid organ transplant (SOT) recipients and may be attributed to immunosuppressive drugs or infectious organisms such as bacteria, viruses or parasites. Cryptosporidium usually causes self-limited diarrhea in immunocompetent hosts. Although it is estimated that cryptosporidium is involved in about 12% of cases of infectious diarrhea in developing countries and causes approximately 748000 cases each year in the United States, it is still an under recognized and important cause of infectious diarrhea in SOT recipients. It may run a protracted course with severe diarrhea, fluid and electrolyte depletion and potential for organ failure. Although diagnostic methodologies have improved significantly, allowing for fast and accurate identification of the parasite, treatment of the disease is difficult because antiparasitic drugs have modest activity at best. Current management includes fluid and electrolyte replacement, reduction of immunosuppression and single therapy with Nitazoxanide or combination therapy with Nitazoxanide and other drugs. Future drug and vaccine development may add to the currently poor armamentarium to manage the disease. The current review highlights key epidemiological, diagnostic and management issues in the SOT population.
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Ehsan MA, Casaert S, Levecke B, Van Rooy L, Pelicaen J, Smis A, De Backer J, Vervaeke B, De Smedt S, Schoonbaert F, Lammens S, Warmoes T, Geurden T, Claerebout E. Cryptosporidium and Giardia in recreational water in Belgium. JOURNAL OF WATER AND HEALTH 2015; 13:870-878. [PMID: 26322773 DOI: 10.2166/wh.2015.268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this study was to investigate the presence of Cryptosporidium and Giardia in different recreational water bodies in Belgium and to estimate the infection risk associated with swimming and other recreational activities. Cryptosporidium oocysts and/or Giardia cysts were detected in three out of 37 swimming pools, seven out of 10 recreational lakes, two out of seven splash parks and four out of 16 water fountains. In the swimming pools no infection risk for Cryptosporidium could be calculated, since oocysts were only detected in filter backwash water. The risk of Giardia infection in the swimming pools varied from 1.13×10(-6) to 2.49×10(-6) per swim per person. In recreational lakes, the infection risk varied from 2.79×10(-5) to 5.74×10(-5) per swim per person for Cryptosporidium and from 7.04×10(-5) to 1.46×10(-4) for Giardia. For other outdoor water recreation activities the estimated infection risk was 5.71×10(-6) for Cryptosporidium and 1.47×10(-5) for Giardia. However, most positive samples in the recreational lakes belonged to species/genotypes that are either animal-specific or predominantly found in animals. No Cryptosporidium was found in splash parks and water fountains, but the presence of Giardia cysts suggests a risk for human infection. The infection risk of Giardia infection during a 3.5-minute visit to a splash park for children equalled 1.68×10(-4).
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Affiliation(s)
- Md Amimul Ehsan
- Laboratory for Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium E-mail: ; †Contributed equally to this work
| | - Stijn Casaert
- Laboratory for Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium E-mail: ; †Contributed equally to this work
| | - Bruno Levecke
- Laboratory for Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium E-mail:
| | - Liesbet Van Rooy
- Agency for Care and Health, Flemish Ministry for Welfare, Public Health and Family, Brussels, Belgium
| | | | - Anne Smis
- Agency for Care and Health, Flemish Ministry for Welfare, Public Health and Family, Brussels, Belgium
| | - Joke De Backer
- Agency for Care and Health, Flemish Ministry for Welfare, Public Health and Family, Brussels, Belgium
| | | | | | - Filip Schoonbaert
- Agency for Care and Health, Flemish Ministry for Welfare, Public Health and Family, Brussels, Belgium
| | | | | | - Thomas Geurden
- Laboratory for Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium E-mail:
| | - Edwin Claerebout
- Laboratory for Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium E-mail:
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Abeywardena H, Jex AR, Gasser RB. A perspective on Cryptosporidium and Giardia, with an emphasis on bovines and recent epidemiological findings. ADVANCES IN PARASITOLOGY 2015; 88:243-301. [PMID: 25911369 PMCID: PMC7103119 DOI: 10.1016/bs.apar.2015.02.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cryptosporidium and Giardia are two common aetiological agents of infectious enteritis in humans and animals worldwide. These parasitic protists are usually transmitted by the faecal-oral route, following the ingestion of infective stages (oocysts or cysts). An essential component of the control of these parasitic infections, from a public health perspective, is an understanding of the sources and routes of transmission in different geographical regions. Bovines are considered potential sources of infection for humans, because species and genotypes of Cryptosporidium and Giardia infecting humans have also been isolated from cattle in molecular parasitological studies. However, species and genotypes of Cryptosporidium and Giardia of bovids, and the extent of zoonotic transmission in different geographical regions in the world, are still relatively poorly understood. The purpose of this article is to (1) provide a brief background on Cryptosporidium and Giardia, (2) review some key aspects of the molecular epidemiology of cryptosporidiosis and giardiasis in animals, with an emphasis on bovines, (3) summarize research of Cryptosporidium and Giardia from cattle and water buffaloes in parts of Australasia and Sri Lanka, considering public health aspects and (4) provide a perspective on future avenues of study. Recent studies reinforce that bovines harbour Cryptosporidium and Giardia that likely pose a human health risk and highlight the need for future investigations of the biology, population genetics and transmission dynamics of Cryptosporidium and Giardia in cattle, water buffaloes and other ruminants in different geographical regions, the fate and transport of infective stages following their release into the environment, as well as for improved strategies for the control and prevention of cryptosporidiosis and giardiasis, guided by molecular epidemiological studies.
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Affiliation(s)
- Harshanie Abeywardena
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Aaron R. Jex
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Robin B. Gasser
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Widerström M, Schönning C, Lilja M, Lebbad M, Ljung T, Allestam G, Ferm M, Björkholm B, Hansen A, Hiltula J, Långmark J, Löfdahl M, Omberg M, Reuterwall C, Samuelsson E, Widgren K, Wallensten A, Lindh J. Large outbreak of Cryptosporidium hominis infection transmitted through the public water supply, Sweden. Emerg Infect Dis 2014; 20:581-9. [PMID: 24655474 PMCID: PMC3966397 DOI: 10.3201/eid2004.121415] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In November 2010, ≈27,000 (≈45%) inhabitants of Östersund, Sweden, were affected by a waterborne outbreak of cryptosporidiosis. The outbreak was characterized by a rapid onset and high attack rate, especially among young and middle-aged persons. Young age, number of infected family members, amount of water consumed daily, and gluten intolerance were identified as risk factors for acquiring cryptosporidiosis. Also, chronic intestinal disease and young age were significantly associated with prolonged diarrhea. Identification of Cryptosporidium hominis subtype IbA10G2 in human and environmental samples and consistently low numbers of oocysts in drinking water confirmed insufficient reduction of parasites by the municipal water treatment plant. The current outbreak shows that use of inadequate microbial barriers at water treatment plants can have serious consequences for public health. This risk can be minimized by optimizing control of raw water quality and employing multiple barriers that remove or inactivate all groups of pathogens.
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Symptomatic and asymptomatic secondary transmission of Cryptosporidium parvum following two related outbreaks in schoolchildren. Epidemiol Infect 2014; 143:1702-9. [PMID: 25268811 PMCID: PMC4416355 DOI: 10.1017/s095026881400243x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Two related outbreaks (in 2009 and 2012) of cryptosporidiosis in Norwegian schoolchildren during a stay at a remote holiday farm provided us with a natural experiment to investigate possible secondary transmission of Cryptosporidium parvum IIa A19G1R1. After the children had returned home, clinical data and stool samples were obtained from their household contacts. Samples were investigated for the presence of Cryptosporidium oocysts by immunofluorescence antibody test. We found both asymptomatic and symptomatic infections, which are likely to have been secondary transmission. Laboratory-confirmed transmission rate was 17% [4/23, 95% confidence interval (CI) 7·0–37·1] in the 2009 outbreak, and 0% (95% CI 0–16·8) in the 2012 outbreak. Using a clinical definition, the probable secondary transmission rate in the 2012 outbreak was 8% (7/83, 95% CI 4·1–16·4). These findings highlight the importance of hygienic and public health measures during outbreaks or individual cases of cryptosporidiosis. We discuss our findings in light of previous studies reporting varying secondary transmission rates of Cryptosporidium spp.
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Cryptosporidium hominis genotypes involved in increased incidence and clusters of cases, Navarra, Spain, 2012. Epidemiol Infect 2014; 143:1033-6. [PMID: 25017000 DOI: 10.1017/s0950268814001836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARY Two clusters of confirmed cryptosporidiosis infections were detected in Navarra, Spain, in the summer of 2012, in the context of an increased incidence in the region. Molecular subtyping of Cryptosporidium hominis determined that one cluster, occurring in an urban area, was due to the predominant circulating subtype IbA10G2R2 and the other cluster, with cases occurring in a rural area, was due to a rare subtype IaA18R3. No single exposure was associated with infection, although exposure to certain children's pools was reported by a majority of patients interviewed in each cluster. Genotyping tools were useful in the investigation and could aid investigation of cryptosporidiosis outbreaks in Spain in the future.
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26
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Effect of sewage treatment plants and diffuse pollution on the occurrence of protozoal parasites in the course of a small river. Int J Hyg Environ Health 2012; 215:577-83. [DOI: 10.1016/j.ijheh.2011.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 12/19/2011] [Accepted: 12/26/2011] [Indexed: 11/17/2022]
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27
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Molecular epidemiology and clinical manifestations of human cryptosporidiosis in Sweden. Epidemiol Infect 2012; 141:1009-20. [DOI: 10.1017/s0950268812001665] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYThis study describes the epidemiology and symptoms in 271 cryptosporidiosis patients in Stockholm County, Sweden. Species/genotypes were determined by polymerase chain reaction–restriction fragment-length polymorphism (PCR–RFLP) of theCryptosporidiumoocyst wall protein (COWP) and 18S rRNA genes. Species wereC. parvum(n=111),C. hominis(n=65),C. meleagridis(n=11),C. felis(n=2),Cryptosporidiumchipmunk genotype 1 (n=2), and a recently described species,C. viatorum(n=2). Analysis of the Gp60 gene revealed fiveC. hominisallele families (Ia, Ib, Id, Ie, If), and fourC. parvumallele families (IIa, IIc, IId, IIe). MostC. parvumcases (51%) were infected in Sweden, as opposed toC. hominiscases (26%). Clinical manifestations differed slightly by species. Diarrhoea lasted longer inC. parvumcases compared toC. hominisandC. meleagridiscases. At follow-up 25–36 months after disease onset, 15% of the patients still reported intermittent diarrhoea. In four outbreaks and 13 family clusters, a single subtype was identified, indicating a common infection source, which emphasizes the value of genotyping for epidemiological investigations.
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A community outbreak of cryptosporidiosis in sydney associated with a public swimming facility: a case-control study. Interdiscip Perspect Infect Dis 2011; 2011:341065. [PMID: 22194741 PMCID: PMC3238377 DOI: 10.1155/2011/341065] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/29/2011] [Indexed: 11/17/2022] Open
Abstract
In February, 2008, the South Eastern Sydney Illawarra Public Health Unit investigated an outbreak of cryptosporidiosis within the south east region of Sydney, Australia. Thirty-one cases with laboratory-confirmed cryptosporidiosis and 97 age- and geographically matched controls selected by random digit dialling were recruited into a case-control study and interviewed for infection risk factors. Cryptosporidiosis was associated with swimming at Facility A (matched odds ratio = 19.4, 95% confidence interval: 3.7–100.8) and exposure to household contacts with diarrhoea (matched odds ratio = 7.7, 95% confidence interval: 1.9–31.4) in multivariable conditional logistic regression models. A protective effect for any animal contact was also found (matched odds ratio = 0.2, 95% confidence interval: 0.1–0.7). Cryptosporidium hominis subtype IbA10G2 was identified in 8 of 11 diagnostic stool samples available for cases. This investigation reaffirms the importance of public swimming pools as potential sources of Cryptosporidium infection and ensuring their compliance with water-quality guidelines. The protective effect of animal contact may be suggestive of past exposure leading to immunity.
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29
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A statewide outbreak of Cryptosporidium and its association with the distribution of public swimming pools. Epidemiol Infect 2011; 140:1439-45. [PMID: 21943664 DOI: 10.1017/s0950268811000987] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In order to characterize the association between county-level risk factors and the incidence of Cryptosporidium in the 2007 Iowa outbreak, we used generalized linear mixed models with the number of Cryptosporidium cases per county as the dependent variable. We employed a spatial power covariance structure, which assumed that the correlation between the numbers of cases in any two counties decreases as the distance between them increases. County population size was included in the model to adjust for population differences. Independent variables included the number of pools in specific pool categories (large, small, spa, wading, waterslide) and pool-owner classes (apartment, camp, country club or health club, hotel, municipal, school, other) as well as the proportion of residents aged <5 years. We found that increases in the number of bigger pools, pools with more heterogeneous mixing (municipal pools vs. country club or apartment pools), and pools catering to young children (wading pools) are associated with more cases at the county level.
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RIMHANEN-FINNE RUSKA, SAKARI JOKIRANTA T, VIRTANEN MIKKOJ, KUUSI MARKKU. Giardia and Cryptosporidium infection in Finland: a registry-based study of their demographic determinants. APMIS 2011; 119:735-40. [DOI: 10.1111/j.1600-0463.2011.02759.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Abd El Kader NM, Blanco MA, Ali-Tammam M, Abd El Ghaffar AERB, Osman A, El Sheikh N, Rubio JM, de Fuentes I. Detection of Cryptosporidium parvum and Cryptosporidium hominis in human patients in Cairo, Egypt. Parasitol Res 2011; 110:161-6. [PMID: 21607688 DOI: 10.1007/s00436-011-2465-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 05/13/2011] [Indexed: 11/24/2022]
Abstract
Cryptosporidium is a significant cause of diarrheal disease in developing and industrialized nations. Cryptosporidium hominis and Cryptosporidium parvum are the main agents of cryptosporidiosis in humans. In Egypt, very little is known about genetic structure of Cryptosporidium spp. Therefore, this study was designed to examine samples from sporadic cases of cryptosporidiosis in Egyptians in order to identify the species involved in infection as well as the transmission dynamics and distribution of the parasite in the Great Cairo area. A total of 391 human faecal samples were collected, between May 2008 and March 2009, from ten public hospitals in Great Cairo. Initial screening by immunochromatographic detection kit "the Stick Crypto-Giardia; Operon" showed 23 possible positive cases. Twenty of them were confirmed by microscopic examination. PCR was performed by amplification of the oocyst wall protein (COWP) gene where 18 out of 23 samples were positive, one not detected by microscopy. Cryptosporidium genotyping was performed by RFLP analysis of PCR products of the diagnosis PCR. Only 15 samples rendered a digestion pattern. The genotyping distribution was nine cases showing C. hominis genotype, three showing C. parvum genotype and three showing mixed infection by C. hominis and C. parvum. The data showed an elevated prevalence of C. hominis (80.0%), the most anthroponotic species, suggesting a human-human transmission. Furthermore, the presence of up to 40% of samples infected with C. parvum shows that further investigations are required to determine the subgenotypes of C. parvum to clarify the mode of transmission in order to improve the control measures.
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Affiliation(s)
- Nour M Abd El Kader
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
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32
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Quah JX, Ambu S, Lim YAL, Mahdy MAK, Mak JW. Molecular identification of Cryptosporidium parvum from avian hosts. Parasitology 2011; 138:573-577. [PMID: 21232175 DOI: 10.1017/s0031182010001691] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cryptosporidium species are protozoan parasites that infect humans and a wide variety of animals. This study was aimed at identifying Cryptosporidium species and genotypes isolated from avian hosts. A total of 90 samples from 37 different species of birds were collected throughout a 3-month period from April 2008 to June 2008 in the National Zoo of Kuala Lumpur, Malaysia. Prior to molecular characterization, all samples were screened for Cryptosporidium using a modified Ziehl-Neelsen staining technique. Subsequently samples were analysed with nested-PCR targeting the partial SSU rRNA gene. Amplicons were sequenced in both directions and used for phylogenetic analysis using Neighbour-Joining and Maximum Parsimony methods. Although 9 (10%) samples were positive for Cryptosporidium via microscopy, 8 (8.9%) produced amplicons using nested PCR. Phylogenetic trees identified all the isolates as Cryptosporidium parvum. Although C. parvum has not been reported to cause infection in birds, and the role of birds in this study was postulated mainly as mechanical transporters, these present findings highlight the significant public health risk posed by birds that harbour the zoonotic species of Cryptosporidium.
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Affiliation(s)
- J X Quah
- International Medical University, 126 Jalan 19/155B, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
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Cryptosporidiosis from a community swimming pool: outbreak investigation and follow-up study. Epidemiol Infect 2009; 137:1651-4. [DOI: 10.1017/s0950268809002696] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYTri-County Health Department investigated an outbreak of cryptosporidiosis linked to a community swimming pool. A cohort study was conducted in 37 persons who were invited to the pool party; 12 (57%) of 21 attendees had primary cryptosporidiosis infection. Risk factors for illness included swimming, getting water in mouth, and swallowing water. The pool met chlorination guidelines and used UV light irradiation, a supplemental disinfection technology that inactivatesCryptosporidium. A follow-up survey of the cohort was completed 7–8 weeks after the pool party; four (25%) of 16 non-attendees had secondary cryptosporidiosis infection. The median duration of illness, including patients with recurring symptoms, was 26 days. Clinical response rate to nitazoxanide, a therapeutic agent, was 67%. This study is unique because it describes a cryptosporidiosis outbreak from a well-maintained community swimming pool using supplemental disinfection. It also reports information on disease burden and treatment response.
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Doménech-Sánchez A, Olea F, Berrocal CI. [Infections related to recreational waters]. Enferm Infecc Microbiol Clin 2009; 26 Suppl 13:32-7. [PMID: 19100165 DOI: 10.1157/13128778] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recreational waters are a source of infection by several microorganisms causing acute gastrointestinal, cutaneous and respiratory illnesses. Cryptosporidium, noroviruses and enteropathogenic Escherichia coli strains are the most important causes of diarrhea, while Pseudomonas and Staphylococcus aureus are the main causes of cutaneous infections, and Legionella is the major cause of acute lower respiratory disease. Approximately 90% of outbreaks occur in treated recreational waters (swimming pools, spas and recreational parks), while the remaining 10% arise from natural waters used for leisure (bathing in rivers, beaches, etc). In spas, most infections are caused by thermophilic bacteria, such as Pseudomonas and Legionella, since overgrowth of these bacteria is facilitated by the direct effect of temperature and, indirectly, by the evaporation of the disinfectant. Outbreaks related to recreational waters usually reflect deficient control of the system: a low level of disinfectant, or the use of an inappropriate disinfectant, insufficient maintenance and cleaning of the installation, higher than recommended usage, and failure of the disinfectant dosage system. The correct design, maintenance and use of these facilities drastically lower the risk of infections from recreational waters. Thus, other key actions to minimize this risk are the existence of, and compliance with, regulatory rules, as well as educational campaigns on good hygiene practices directed at users. Rapid etiologic diagnosis of affected patients, together with an epidemiological survey and detection of the pathogen implicated in water samples are the keys to outbreak control.
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Molecular typing of Cryptosporidium parvum associated with a diarrhoea outbreak identifies two sources of exposure. Epidemiol Infect 2007; 136:1147-52. [PMID: 17961283 DOI: 10.1017/s0950268807009673] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An outbreak of cryptosporidiosis associated with exposure to outdoor swimming-pool water affected an estimated 800-1000 individuals. PCR products were obtained from faecal specimens from 30 individuals who tested positive for Cryptosporidium oocysts. RFLP and sequencing analyses showed that all individuals were infected with Cryptosporidium parvum. Among the infected individuals, five had just swum in an adjacent indoor pool during the same period, and had no identified contact with individuals linked to the outdoor pool. With the use of subgenotyping based on analysis of three mini- and microsatellite loci, MS1, TP14, and GP15, we could identify two sources of exposure. One subtype was associated with the outdoor pool and another with the indoor pool. These data demonstrate that the use of mini- and microsatellite loci as markers for molecular fingerprinting of C. parvum isolates are valuable in the epidemiological investigation of outbreaks.
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Sartorius B, Andersson Y, Velicko I, De Jong B, Löfdahl M, Hedlund KO, Allestam G, Wångsell C, Bergstedt O, Horal P, Ulleryd P, Soderstrom A. Outbreak of norovirus in Västra Götaland associated with recreational activities at two lakes during August 2004. ACTA ACUST UNITED AC 2007; 39:323-31. [PMID: 17454896 DOI: 10.1080/00365540601053006] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A large community outbreak of norovirus (NV) gastrointestinal infection occurred in Västra Götaland County, Sweden in August 2004, following attendance at recreational lakes. A frequency age-matched case control study was undertaken of persons who had attended these lakes to identify risk factors. 163 cases and 329 controls were included. Analysis indicates that having water in the mouth while swimming (OR=4.7; 95% CI 1.1-20.2), attendance at the main swimming area at Delsjön Lake (OR=25.5; 95% CI 2.5-263.8), taking water home from a fresh water spring near Delsjön lake (OR=17.3; 95% CI 2.7-110.7) and swimming less than 20 m from shore (OR=13.4; 95% CI 2.0-90.2) were significant risk factors. The probable vehicle was local contamination of the lake water (especially at the main swimming area). The source of contamination could not be determined.
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Affiliation(s)
- Benn Sartorius
- European Programme for Intervention Epidemiology Training (EPIET), Solna, Sweden.
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Samie A, Bessong PO, Obi CL, Sevilleja JEAD, Stroup S, Houpt E, Guerrant RL. Cryptosporidium species: Preliminary descriptions of the prevalence and genotype distribution among school children and hospital patients in the Venda region, Limpopo Province, South Africa. Exp Parasitol 2006; 114:314-22. [PMID: 16806189 DOI: 10.1016/j.exppara.2006.04.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 04/15/2006] [Accepted: 04/24/2006] [Indexed: 10/24/2022]
Abstract
In the present study, the prevalence and species distribution of Cryptosporidium among school children and hospital patients in the Venda region of South Africa was determined. Real time PCR (qPCR) was used for initial screening to detect positive samples while a nested PCR followed by restriction fragment length polymorphism was used to determine the species genotype. From a total of 244 stool samples tested, 44 (18%) had Cryptosporidium with no significant difference (chi(2)=0.04; P=0.841) between samples collected from patients attending hospitals 36/197 (18%) and the samples from primary schools 8/47 (17%). The age groups most affected were those from 2 to 5 years old (28.6%) and 50 to 59 years old (50.0%). Cryptosporidium was detected in 4 (12.5%) of the 31 HIV positive individuals. Fifty-seven percent of the Cryptosporidium positive samples were diarrheic and 26 (59.1%) had elevated lactoferrin content. C. hominis (82%) was more common than C. parvum (18%). This study has demonstrated the high prevalence of Cryptosporidium infections in the Venda region and its implications in causing diarrhea and inflammation.
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Affiliation(s)
- A Samie
- Department of Microbiology, University of Venda for Science and Technology, Thohoyandou 0950, South Africa.
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Pandak N, Zeljka K, Cvitkovic A. A family outbreak of cryptosporidiosis: Probable nosocomial infection and person-to-person transmission. Wien Klin Wochenschr 2006; 118:485-7. [PMID: 16957980 DOI: 10.1007/s00508-006-0637-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 05/23/2006] [Indexed: 11/28/2022]
Abstract
Cryptosporidium is an important cause of community gastroenteritis, usually associated with drinking contaminated water, visits to swimming pools or animal exposure. In immunocompetent patients, cryptosporidiosis is usually a self-limiting disease but it can be devastating illness in immunocompromised persons. This report presents a family outbreak of cryptosporidiosis and describes a probable nosocomial infection with Cryptosporidium in one patient and subsequent spread of the parasite among members of his family. The index patient, a 72-year-old man with hemiparesis after his third stroke, died after 28 days of persistent diarrhea. Control measures must be undertaken to prevent nosocomial transmission of cryptosporidial oocysts.
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Affiliation(s)
- Nenad Pandak
- Department of Infectious Diseases, General Hospital Dr. Josip Bencevic, Slavonski Brod, Croatia.
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