Criptosporidiose: uma revisão sobre a sua implicação na conservação dos mamíferos aquáticos / Cryptosporidiosis: a review about its implication in conservation of aquatic mammals

A criptosporidiose é uma doença parasitária emergente que vem sendo relatada em diversas espécies de mamíferos, incluindo os aquáticos. Esta revisão trata da epidemiologia da infecção por Cryptosporidium spp. em mamíferos aquáticos. A idade dos animais, dose infectante e o estado imunológico podem influenciar na apresentação clínica, e quando associados a outros patógenos pode levar o animal a óbito. A contaminação dos recursos hídricos constitui um dos principais meios de disseminação do parasito, que foi identificado por diferentes técnicas de análise. A adequação das estruturas de saneamento, utilização de métodos apropriados para a inativação dos oocistos e garantia das normas de higiene pessoal constituem algumas das maneiras recomendadas para minimizar a disseminação do Cryptosporidium entre os mamíferos aquáticos.

Cryptosporidiosis is an emerging parasitic disease that has been related in several mammal species, including the aquatic ones. This review covers the epidemiology infection by Cryptosporidium spp. in aquatic mammals. The age of the animal, infecting dose and immunological state can influence on the clinical presentation, and when associated with other pathogen, can lead the animal to death. The water supply contamination is water supply is one of the major ways of the pathogen dissemination, which was being identified by different techniques of laboratorial analysis. The adequacy of sanitation structures, the use of appropriate method to inactivate the oocysts and the assurance of personal hygiene norms are some of the recommended way to minimize the dissemination of Cryptosporidium among aquatic mammals.

Prevalence of cryptosporidiosis in HIV-infected patients in Kajang Hospital, Selangor.

A total of 66 fecal specimens obtained from patients infected with human immunodeficiency virus (HIV) from Kajang Hospital were screened for Cryptosporidium oocysts. The fecal specimens were concentrated using the formalin ethyl acetate concentration technique, stained with modified Ziehl-Neelsen and confirmed with immunofluorescence stain. It was established that 2 (3.0%) were positive for Cryptosporidium. The two cases involved a Chinese local man (with diarrhea) and an Indonesian foreigner (without diarrhea). A higher index of suspicion for clinical cryptosporidiosis in HIV patients, including those with chronic weight loss with or without diarrhea, is recommended. In addition, laboratory testing for Cryptosporidium in HIV-infected patients is highly recommended in order to have a better understanding of the epidemiology and management of the disease in Malaysia.

Coinfection of Cryptosporidium and Geotrichum in a case of AIDS.

A 32 year old male, positive for human immunodeficiency virus (mY) antibodies, was found to be positive for multiple opportunistic infections by a parasite and a fungi, which is a very rare occurrence. Cryptosporidium and Geotrichum were simultaneously detected from his stool and sputum respectively.

Comparison of Cryptosporidium parvum development in various cell lines for screening in vitro drug testing.

This study describes the development of Cryptosporidium parvum in MDCK, MA-104, Hep-2 and Vero cell lines. Differences in susceptibility, infectivity, and the methodology of excystation were determined. Various solutions were considered to determine the factors which enhanced the excystation (eg with and without sodium hypochlorite, trypsin or sodium taurocholate). It was shown that the sporozoites could be excysted in media either with or without trypsin and sodium taurocholate, but the number of sporozoites in the latter solution was less than the former one. Only oocysts digested by sodium hypochlorite and trypsin can enter the culture cells. Numerous meronts and oocysts were demonstrated and persisted for 9 days. Asexual stages were not observed in MA-104. Only few oocysts could be detected 1-3 days post-inoculation. There was a significant difference between the number of oocysts, which invaded MDCK, MA-104, and Hep-2 cells. MDCK gave the highest susceptibility to oocyst invasion among the three cell lines and asexual stages were also found. Among the 25 isolates, which had been cultivated, 23 isolates could infect MDCK and Hep-2. Only 2 isolates could not infect the MDCK cell. These 2 isolates could infect the Vero cell and yielded high numbers of trophozoites. Praziquantel (PZQ), doxycycline, and paromomycin (PRM) were tested on the infecting parasites. The drugs were added either with the inoculum or 24 hours after inoculation. None of them was effective, including PRM, which had been previously reported as effective.

X-linked Hyper-IgM Syndrome Associated with Cryptosporidium parvum and Cryptococcus neoformans Infections: the First Case with Molecular Diagnosis in Korea

X-linked hyper-IgM syndrome (XHIM) is a rare primary immunodeficiency disorder, caused by mutations of the gene encoding CD40 ligand (CD40L; CD154). We report the clinical manifestations and mutational analysis of the CD40L gene observed in a male patient from a XHIM family. Having hypogammaglobulinemia and elevated IgM, the 3-yr-old boy exhibited the characteristic clinical features of XHIM. The patient suffered from frequent respiratory infections, and chronic enteritis caused by Cryptosporidium parvum. In addition, a lymph node biopsy and a culture from this sample revealed C. neoformans infection. Activated lymphocytes from the patient failed to express CD40L on their surface as assessed by flow cytometry and a missence mutation (W140R) was found at the XHIM hotspot in his CD40L cDNA to confirm the diagnosis. Genetic analysis of the mother and sister showed a heterozygote pattern, indicating carrier status. To our knowledge, this is the first report on the molecular diagnosis of an XHIM patient in Korea.

Low prevalence of Cryptosporidium parvum in hospitalized children in Kota Bharu, Malaysia.

The aim of this prospective study was to determine the prevalence of Cryptosporidium parvum in hospitalized children in Kota Bharu, Malaysia. Over a 19 month study period, 258 stool samples were examined from 159 children; 109 with diarrhea and 50 controls without diarrhea. Modified Ziehl-Neelsen staining method and a polymerase chain reaction (PCR) assay were used to detect C. parvum and the samples were also examined for the presence of other intestinal parasites. Only 1 of the 109 (0.9%) children with acute diarrhea was positive for C. parvum by microscopy and PCR. Thirty-one percent of children were infested with other intestinal parasites, the most common being Ascaris lumbricoides and Trichuris trichiura. In conclusion, we found C. parvum to be an uncommon infective agent in hospitalized children with or without diarrhea in Kota Bharu, Malaysia.

A report case of Cyclospora and Cryptosporidium mixed infection in a HIV-negative child in Thailand.

The first case of cyclosporosis in a non HIV-infected child in Thailand, co-infected with Cryptosporidium, was reported. The patient was a 3 year-old malnourished orphan who presented with fever, abdominal distension and relapsing diarrhea. There was no leukocyte in her stool, however, numerous Cyclospora and Cryptosporidium oocysts were identified by modified acid-fast staining. The illness was cured by co-trimoxazole and fluid therapy. More coccidial infections in Thailand may be detected if modified acid-fast staining is routinely performed.

Cryptosporidium and HIV.

To study the importance of cryptosporidium as a diarrhoea causing pathogen (using stool samples), a cohort study was conducted from 14-9-1994 to 14-3-1995 on injecting drug users in Imphal. Stool samples were also collected from close contacts of the patients of human immunodeficiency virus (HIV) infected cryptosporidium diarrhoea cases and patients of paediatric medicine ward of Regional Institute of Medical Sciences (RIMS), Imphal. A total of 9 cases of cryptosporidium diagnosed out of 11 HIV infected diarrhoea cases and 2 out of 11 personal contacts were found to be positive. Two cases with history of close contacts with HIV infected cryptosporidium diarrhoea cases were not suffering from diarrhoea. One out of 7 paediatric diarrhoea cases was found to be positive. Five out of 9 HIV infected cryptosporidial cases died within one month of diagnosis of cryptosporidium. The remaining 4 had improved and diarrhoea was controlled. One of the 4 did not show cryptosporidium any more in the stool sample.

Criptosporidiosis en niños con diarrea aguda de la Provincia de Ciego de Avila / Cryptospodidiosis in children with acute diarrhea from Ciego de Avila Province, Cuba

An epidemiological and clinical study of criptosporidiosis in children from Ciego de Avila province was carried out from 1987 to 1994. During this period 14,895 children with acute diarrhea were studied. Cryptosporidium sp. oocysts were found in the feces of 1,256 (8.4 percent) of them. Isolated cases prevailed over outbreaks, being the incidence rate proportional in both urban and rural areas. Seventy nine point seven per cent of infected children were less one year old, predominating the age group 6-11 months old. No influence of seasons on the occurrence of the parasitose was observed. The most frequently detected symptoms and signs were diarrhea, vomits and loss of weight. The main epidemiological factors were: 8 1.0 percent of ill children drank water directly from the aqueduct, 12.8 percent lived in overcrowded conditions, 1 1.0 percent had animals and 10.7 percent attended nursery schools

Criptospiridiasis respiratoria en un paciente con SIDA

Se presenta un paciente colombiano, adulto de sexo masculino, con diagnóstico de SIDA, que presentó enfermedad entérica y pulmonar causada por Cryptosporidium. Se discute diferentes aspectos relacionados con la criptosporidiosis humana y se comparan con lo informado en la literatura médica

Cryptosporidiosis in HIV infected patients in Thailand.

Diarrhea, mostly chronic diarrhea and weight loss are common in patients with AIDS. Cryptosporidium had been identified as responsible for chronic, debilitating secretory diarrhea in HIV infected patients. We performed a retrospective study of the prevalence, clinical features and laboratory findings of cryptosporidiosis in HIV infected patients (adults and children), in the period of 6 years from January 1988 to December 1993 at Bamrasnaradura Hospital in Nonthaburi, Thailand. In this study, Cryptosporidium was found in 22 (8.8%) by detection in stool specimens of 250 HIV infected patients with diarrhea and was found throughout the year. The prevalence rates of cryptosporidiosis in this study among children and adults were 19% and 7.9%, respectively. The common features were chronic diarrhea (84.6%), mostly watery diarrhea and weight loss/malnutrition (100%). A few fecal leukocytes were found in 15.4%.

Assessment of the immune and nutritional status of the host in childhood diarrhoea due to cryptosporidium.

Cryptosporidium oocysts were detected microscopically in the concentrated faecal smears (stained by modified kinyoun's acid fast stain) in 13 out of 100 (13 per cent) cases of acute diarrhoea (AD < 2 weeks duration), 7 out of 50 (14 per cent) cases of chronic diarrhoea (CD > 2 weeks duration) and none in 50 age matched controls. The grades of malnutrition of the cases and controls were calculated by the weight for age criteria and the immune status assessed by the levels of serum immunoglobulins and SIgA in duodenal fluids. Malnutrition was observed in 6 out of 13 cases (46.1 per cent) in acute and 6 out of 7 cases (85.71 per cent) in chronic cryptosporidial diarrhoeas. There was no significant statistical difference (P > 0.05) in serum immunoglobulins and SIgA levels in chronic cryptosporidiosis. SIgA was significantly reduced (P > 0.05) in cases of acute cryptosporidiosis. Cryptosporidium is an important cause of symptomatic infection in apparently immunocompetent children not having been detected in a single non-diarrhoeal control. Further a low SIgA could contribute to acute symptomatic cryptosporidiosis by favouring colonization with the parasite.

Gastritis erosiva asociada a criptosporidium en dos pacientes con SIDA / Erosive gastritis associated to the cryptosporidium in 2 patients with AIDS

La aparición de vómitos y diarrea en pacientes con síndrome de inmunodeficiencia adquirida ha sido atribuido frecuentemente a organismos enteropatógenos que invaden el tracto gastrointestinal como consecuencia del trastorno inmunológico del huésped. El cryptosporidium ha sido detectado con alguna prevalencia y su localización predominante es el tracto gastrointestinal, a pesar que otros sitios han sido notificados. Se presentan dos casos con diagnóstico endoscópico de gastritis congestiva-erosiva con presencia de criptosporidium en las biopsias gástricas. Ambos pacientes cursaban un estadío terminal de su enfermedad

Some epidemiological aspects of cryptosporidiosis in Ahwaz, capital of Khoozestan province, Islamic Republic of Iran

From December 1990 to June 1992 in Ahwaz, capital of Khoozestan province, 1333 patients referred to Khoozestan Parasitology Center, in 29 cases of whom Cryptosporidium parvum was detected. All infected patients were less than eight years of age. The parasite was most prevalent in the 0-1 year old age group. Though some C. parvum infected cases harboured Giardia lamblia, there was no relationship between the two infections. Similarly, there was no relationship with Blastocystis hominis either. Females [19/29] were significantly more commonly infected than males [10/29]. The majority of cases [19/29] were detected from October to April when the weather temperature varied from 2°C to 30°C and the humidity was above 70%. However, no infected case was found during August and September, when the weather temperature was above 45°C and humidity was below 30%. Only 2 out of 29 were in direct contact with cattle and sheep. It is probable that the consumption of contaminated drinking tap-water was the main factor of cryptosporidium oocyst dissemination in this area

Infección por Crytosporidium sp. en individuos cubanos infectados por el VIH / Cryptosporidium sp. infection in Cuban individuals infected by HIV

Se investiga la presencia de Cryptosporidium sp. en 47 pacientes adultos cubanos infectados por VIH en diferentes estadios de la infección para estimar por primera vez su prevalencia en este grupo. Se encontró la presencia de parásito en 18 pacientes (38,3 por ciento ) de los cuales 8 (44,7 por ciento ) eran asintomáticos. Los síntomas más frecuentes fueron diarreas acuosas, fiebre, cólicos abdominales, astemia y pérdida de peso. Se resalta el carácter con frecuencia asintomático de estas infecciones, lo que pudiera constituir un importante reservorio para la transmisión nosocomial entre estos individuos con disregulaciones de la inmunidad