To understand the transmission of Cryptosporidium infection in children, fecal specimens from 62 Kuwaiti children with gastrointestinal symptoms found to be positive by microscopy were genotyped and subtyped with a small subunit rRNA-based PCR-restriction fragment length polymorphism analysis and a 60-kDa glycoprotein-based DNA sequencing tool. The median age of infected children was 4.5 years, and 77% of infections occurred during the cool season of November to April. Fifty-eight of the children (94%) had Cryptosporidium parvum, three (5%) had Cryptosporidium hominis, and one (1%) had both C. parvum and C. hominis. Altogether, 13 subtypes of C. parvum (belonging to four subtype allele families) and C. hominis (belonging to three subtype allele families) were observed, with 92% of specimens belonging to the common allele family IIa and the unusual allele family IId. Thus, the transmission of cryptosporidiosis in Kuwaiti children differed significantly from other tropical countries.Cryptosporidiosis is a significant cause of diarrheal diseases in both developing and industrialized nations. Recent molecular epidemiologic studies of cryptosporidiosis have helped researchers to better understand the transmission of cryptosporidiosis in humans and the public health significance of Cryptosporidium spp. in animals and the environment. Using genotyping tools, five species of Cryptosporidium (C. hominis, C. parvum, C. meleagridis, C. felis, and C. canis) have been shown to be responsible for most human infections. Of these five species, C. hominis and C. parvum are the two most common species (34). Because these five human pathogenic Cryptosporidium species have different spectrums of host specificity, the characterization of Cryptosporidium at the species level is useful in investigating infection and contamination sources. Recently, a number of subtyping tools have been developed and used to characterize the population structure and transmission dynamics of C. parvum and C. hominis (2, 8, 17, 18, 24-26, 29, 30).Although cryptosporidiosis is prevalent in tropical regions, limited studies have been conducted to characterize Cryptosporidium spp. from humans at the molecular level. Several studies have examined the transmission of human cryptosporidiosis in South Africa, Malawi, Kenya, Uganda, Peru, and Thailand, all of which have shown a predominance of C. hominis in humans, indicating anthroponotic transmission plays a major role in the epidemiology of cryptosporidiosis in most tropical countries (7,17,25,(31)(32)(33). Only two of the studies subtyped small numbers of Cryptosporidium spp. (17,25). In the present study, 62 Cryptosporidium-positive specimens were collected from children in Kuwait City between 1997 and 2004 and examined by a small subunit (SSU) rRNA-based PCR-restriction fragment length polymorphism (PCR-RFLP) analysis and a 60-kDa glycoprotein (GP60)-based PCR sequencing tool (2, 33). Results of the study have shown a predominance in children of C. parvum, which traditionally is associated with farm animal...

Conventional light microscopy has been the established method for malaria diagnosis. However, recently several nonmicroscopic rapid diagnostic tests have been developed for situations in which reliable microscopy may not be available. This study was conducted to evaluate the diagnostic performance of a recently introduced ICT Malaria Pf/Pv test. This assay detects Plasmodium falciparum histidine-rich protein 2 antigen (PfHRP-2) for P. falciparum diagnosis and pan-malarial antigen for P. vivax diagnosis. In this study we compared the performance of ICT Malaria Pf/Pv with microscopy of Giemsa-stained blood films and with an OptiMAL test that detects Plasmodium lactate dehydrogenase (pLDH) antigen. A total of 750 clinically suspected malaria patients were examined at local health centers in Kuwait. Both the antigen tests had a high degree of specificity (>98%) for detection of malaria infection. However, they were less sensitive than microscopy. Compared with microscopy the ICT Malaria PF/pf test failed to detect malaria infection in 93 (34%) of 271 malaria patients (11% of patients with P. falciparum and 37% of patients with P. vivax) and the OptiMAL test failed to detect malaria infection in 41 (15%) of 271 malaria patients (7% of patients with P. falciparum and 13% of patients with P. vivax). The sensitivities of the ICT Malaria Pf/Pv and OptiMAL tests for detection of P. falciparum infection were 81 and 87%, and those for detecting P. vivax were 58 to 79%, respectively. The sensitivity of the ICT Malaria Pf/Pv and OptiMAL tests decreased significantly to 23 and 44%, respectively, at parasite densities of <500/l. Both of the tests also produced a number of false-positive results. Overall, the performance of the OptiMAL test was better than that of the ICT Malaria Pf/Pv test. However, our results raise particular concern over the sensitivity of the ICT Malaria Pf/Pv test for detection of P. vivax infection. Further developments appear necessary to improve the performance of the ICT Malaria Pf/Pv test.

We tested 240 patients with Plasmodium falciparum monoinfection for persistent parasite antigenemia after successful standardized antimalarial therapy by using the ICT Malaria Pf/Pv and OptiMAL-IT assays that detect the malaria antigens Plasmodium falciparum histidine-rich protein 2 (HRP2) and parasite lactate dehydrogenase (pLDH), respectively, as well as a panmalarial antigen (PMA). The patients were screened for antigenemia on days 0, 3, 7, and 14 of follow-up. On day 0, all 240 patients showed positive reactivity with both assays. Of the 229 cases with negative parasitemia on day 3, persistent antigenemia was observed in 207 (90.4%) of the cases: 188 (82.1%) for HRP2 antigen and 75 (32.8%) for PMA. There was a gradual decrease in antigenemia on follow-up to day 14; however, the drop in reactivity to PMA was less than that for HRP2 antigen. In contrast to HRP2 antigenemia, there was a significant decrease in pLDH antigenemia to 38.4% and to 14.8% (PMA) on day 3 (P < 0.03). The pLDH antigenemia level dropped further to 14.8% on day 7. There was no significant association of persistent antigenemia with gametocytemia. One case with gametocytemia was negative for both the antigens. In conclusion, the OptiMAL-IT assay is more sensitive than the ICT Malaria Pf/Pv test for monitoring therapeutic responses after antimalarial therapy since the LDH activity ceases when the malarial parasite dies.Clinical diagnosis of malaria still relies upon identification of malaria parasites in Giemsa-stained blood smears of the peripheral blood. Recently, rapid diagnostic tests for the detection of Plasmodium falciparum infection has been introduced to overcome the problem of time constraints and low sensitivity in diagnosing malaria infections with a low level of parasitemia by microscopy. These rapid diagnostic tests are the immunochromatographic tests (ICT) based on the detection of antigen(s) released from the parasitized red blood cells. In the case of P. falciparum infection, these new rapid methods are based on detection of the histidine-rich protein 2 (HRP2; e.g., the ICT Malaria Pf, ParaSight-F, and ICT Malaria Pf/Pv tests) (1-6, 11, 20) or parasite lactate dehydrogenase (pLDH; e.g., OptiMAL-IT) (7-9, 11, 18-20). The sensitivities and specificities of each of these tests have been assessed in a range of clinical situations (1,2,5,7,11,19), although the overall sensitivity and specificity of all of these assays to detect P. falciparum infection is high (Ͼ90%). However, the sensitivity of these assays decreases to Ͻ70% in parasitemia Ͻ50/l. Further, these assays may remain positive due to persistence of P. falciparum HRP2 antigenemia after antimalarial therapy. This may result in a false-positive (FP) diagnosis of infection and thus may reduce the usefulness of the test in predicting treatment failure (4,11,12,19). FP reactions have been reported in individuals with a history of recent fever and antimalarial treatment due to persistent circulation of HRP2 for up to 2 weeks after clearance of parasites or in patients who had...

Myiasis, the invasion of live human tissue by larvae of Diptera, is reported in the nasopharynx and a leg wound in two patients who were hospitalized for more than 72 hours in Mubarak Al-Kabeer Teaching Hospital in Kuwait City, Kuwait. On the fourth and fifth days after a 10-year-old Kuwaiti boy was admitted to the hospital intensive care unit in a bloodied and comatose state following a traffic accident, 'worms' that came out of his nostrils were fixed, cleared, and identified as second and third instar of Lucilia sericata (Diptera: Calliphoridae). After 14 days, 'worms' were seen in the original dressing of a 35-year-old Iranian man admitted to the Orthopedic Unit of the hospital with multiple lacerations and fractures. The larvae, in various stages of development, were identified as those of Megaselia scalaris (Diptera: Phoridae). Since the presence of larvae in both patients was recorded after a stay of at least 3-4 days in the hospital, by definition, these infestations are considered nosocomial.

Abstract. This study was conducted to evaluate the performance of two rapid non-microscopic assays: Plasmodium lactate dehydrogenase (pLDH) assay (OptiMAL) and Plasmodium falciparum histidine-rich protein 2 (PfHRP-2) assay (ICT Malaria). The assays were used to detect malaria infection in 515 immigrants living in Kuwait. The performance of both assays was compared to that of microscopy of Giemsa-stained thick blood films and to each other. Of the 515 patients tested, 163 were positive for malaria parasites by microscopy of thick blood film. Of these, 87 were infected with Plasmodium vivax parasites, 63 with P. falciparum, 1 with Plasmodium malariae, and 12 had mixed infections of P. falciparum and P. vivax. The PfHRP-2 assay detected 53 P. falciparum infections and, as expected, failed to detect all but one case of P. vivax. Three cases of mixed infections were also not detected by this assay. The pLDH assay detected 56 P. falciparum cases and 77 P. vivax infections but failed to detect 4 cases of mixed infections. Compared to microscopy, the performance of both the assays to diagnose P. falciparum infection was comparable. The sensitivity for the PfHRP-2 assay was 82% with a specificity of 99.0% and for the pLDH assay the sensitivity was 89% with a specificity of 99.5%. The PfHRP-2 assay detected 4 false positive cases, 2 of which were also detected by the pLDH assay. These patients reported treatment with chloroquine in the last 2-5 weeks. Though the immunocapture diagnostic assays may be helpful in certain situations, microscopy of thick blood film is still the method of choice in diagnosing imported malaria.