BackgroundCryptosporidiosis is an important cause for chronic diarrhea and death in HIV/AIDS patients. Among common Cryptosporidium species in humans, C. parvum is responsible for most zoonotic infections in industrialized nations. Nevertheless, the clinical significance of C. parvum and role of zoonotic transmission in cryptosporidiosis epidemiology in developing countries remain unclear.Methodology/Principal FindingsIn this cross-sectional study, 520 HIV/AIDS patients were examined for Cryptosporidium presence in stool samples using genotyping and subtyping techniques. Altogether, 140 (26.9%) patients were positive for Cryptosporidium spp. by PCR-RFLP analysis of the small subunit rRNA gene, belonging to C. parvum (92 patients), C. hominis (25 patients), C. viatorum (10 patients), C. felis (5 patients), C. meleagridis (3 patients), C. canis (2 patients), C. xiaoi (2 patients), and mixture of C. parvum and C. hominis (1 patient). Sequence analyses of the 60 kDa glycoprotein gene revealed a high genetic diversity within the 82 C. parvum and 19 C. hominis specimens subtyped, including C. parvum zoonotic subtype families IIa (71) and IId (5) and anthroponotic subtype families IIc (2), IIb (1), IIe (1) and If-like (2), and C. hominis subtype families Id (13), Ie (5), and Ib (1). Overall, Cryptosporidium infection was associated with the occurrence of diarrhea and vomiting. Diarrhea was attributable mostly to C. parvum subtype family IIa and C. hominis, whereas vomiting was largely attributable to C. hominis and rare Cryptosporidium species. Calf contact was identified as a significant risk factor for infection with Cryptosporidium spp., especially C. parvum subtype family IIa.Conclusions/SignificanceResults of the study indicate that C. parvum is a major cause of cryptosporidiosis in HIV-positive patients and zoonotic transmission is important in cryptosporidiosis epidemiology in Ethiopia. In addition, they confirm that different Cryptosporidium species and subtypes are linked to different clinical manifestations.

The prevalence and distribution of Cryptosporidium spp. in the fecal droppings of the free-living waterfowl Canada geese were examined at 13 sites in Ohio and Illinois. On the basis of the analysis of the small-subunit rRNA gene by PCR, followed by restriction fragment length polymorphism analysis and DNA sequencing, 49 (23.4%) of 209 fecal specimens collected from 10 sites (76.9%) were positive for Cryptosporidium spp. The following five Cryptosporidium species and genotypes were identified: Cryptosporidium goose genotype I (in 36 specimens), Cryptosporidium goose genotype II (in 9 specimens), Cryptosporidium duck genotype (in 1 specimen), Cryptosporidium parvum (in 4 specimens), and C. hominis (in 2 specimens). Cryptosporidium goose genotype I was the most prevalent parasite and was found at all five Cryptosporidium-positive sites in Ohio and at four of five positive sites in Illinois, followed by Cryptosporidium goose genotype II, which was found at two of five positive sites in Ohio and at four of five positive sites in Illinois. Cryptosporidium goose genotype II was detected for the first time, and it is phylogenetically related to goose genotype I and the duck genotype. All three genotypes have not so far been reported in humans, and their pathogenicity in geese has not been determined. Only 10.2% of the Cryptosporidium-positive specimens had C. parvum and C. hominis. The results of this study indicate that Canada geese might only serve as accidental carriers of cryptosporidia infectious to humans and probably play a minor role in the animal-to-human transmission cycle of the pathogen.

Most local health departments utilize visual, but not microbiological, methods when inspecting food service operations. To evaluate the marginal utility of microbial testing for minimizing potential risks of foodborne outbreaks in restaurants, swab samples were taken from handwashing sink faucets, freshly cleaned and sanitized food-contact surfaces, and from cooler or freezer door handles in 70 of 350 category-three (high-risk) food service operations in Toledo, Ohio. The swabs were inoculated onto different selective media, and standard procedures were used to identify pathogenic and nonpathogenic bacteria. Microbiological evaluations of the sampled food service operations were compared with visual inspection reports, using a numeric rating scale. Enteric bacteria (that may indicate fecal contamination) were found on food contact surfaces, on cooler or freezer door handles, and on handwashing sink faucets in 86, 57, and 53% of the food service operations, respectively. Approximately 27, 40, and 33% of the restaurants received visual ratings of very poor to poor, fair, and good to very good, respectively. In comparison, 10, 17, and 73% of the restaurants received microbiological rating scores of very poor to poor, fair, and good to very good, respectively. Restaurants with trained personnel received significantly higher visual rating scores than restaurants without trained personnel (P < 0.01). Although more restaurants received poor rating scores by visual inspection than by microbiological evaluation, the presence of fecal bacteria from different sites in more than 50% of the food service operations indicated that visual inspection alone might not be sufficient for minimizing potential risk for foodborne disease outbreaks. Therefore, we recommend periodic microbiological evaluation of high-risk food service operations, in addition to visual inspection, for minimizing the risk of foodborne disease outbreaks.

The unique Ethiopian cultural tradition of the coffee ceremony increases inhalation exposures to combustion byproducts. This pilot study evaluated exposures to particulate matter and carbon monoxide in ten Addis Ababa homes during coffee ceremonies. For coffee preparers the geometric mean (57 μg/m3) and median (72 μg/m3) contributions to an increase in a 24-hour time-weighted average exposure were above World Health Organization (WHO) guidelines. At 40% of the study sites the contribution to the 24-hour average exposure was greater than twice the WHO guideline. Similar exposure increases existed for ceremony participants. Particulate matter concentrations may be related to the use of incense during the ceremony. In nearly all homes the WHO guideline for a 60-minute exposure to carbon monoxide was exceeded. Finding control measures to reduce these exposures will be challenging due to the deeply engrained nature of this cultural practice and the lack of availability of alternative fuels.

Food safety is an important public health issue in the U.S. Eating at restaurants and other food service facilities increasingly has been associated with food borne disease outbreaks. Food safety training and certification of food mangers has been used as a method for reducing food safety violations at food service facilities. However, the literature is inconclusive about the effectiveness of such training programs for improving food safety and protecting consumer health. The purpose of this study was to examine the effect of food manger training on reducing food safety violations. We examined food inspection reports from the Toledo/Lucas County Health Department (Ohio) from March 2005 through February 2006 and compared food hygiene violations between food service facilities with certified and without certified food managers. We also examined the impact on food safety of a food service facility being part of a larger group of facilities.Restaurants with trained and certified food managers had significantly fewer critical food safety violations but more non-critical violations than restaurants without certified personnel. Institutional food service facilities had significantly fewer violations than restaurants, and the number of violations did not differ as a function of certification. Similarly, restaurants with many outlets had significantly fewer violations than restaurants with fewer outlets, and training was not associated with lower numbers of violations from restaurants with many outlets. The value of having certified personnel was only observed in independent restaurants and those with few branches. This information may be useful in indicating where food safety problems are most likely to occur. Furthermore, we recommend that those characteristics of institutional and chain restaurants that result in fewer violations should be identified in future research, and efforts made to apply this knowledge at the level of individual restaurants.