Cryptosporidial Diarrhoea in Children at a Paediatric Hospital in Accra, Ghana

Abstract

Background: Diarrhoeal diseases are common among children in developing countries, and are caused by several aetiological agents including Cryptosporidium sp. Several species of this parasite exist which may belong to either anthroponotic or zoonotic forms. With recent application of molecular tools, species involved in human transmission in any locality and sources of infection can now be determined. Aim: We screened children with acute diarrhoea at a paediatric hospital in Accra, Ghana for enteric parasites to determine frequency of cryptosporidial diarrhoea. Cryptosporidium isolates were then characterized by molecular methods to determine the genetic species in transmission. Methodology: A total of 365 diarrhoeic children of age ≤ 5 years were used in this crosssectional study. Stool samples were collected and tested for enteric parasites by microscopy and ELISA. Cryptosporidium isolates were subsequently genotyped by PCR-RFLP and confirmed by sequencing of the 18S rRNA gene. Demographic and clinical data were obtained by a structured questionnaire and data analysed for possible association with cryptosporidial diarrhoea. Results: Enteric parasites detected were Cryptosporidium sp. (22.2%), G. lamblia (5.8%) and E. histolytica (0.8%). Neither gender nor breastfeeding habits, presence of domestic animals, source of children's food, seasons (dry or rainy) appeared to be associated with infection of Cryptosporidium sp. However, age of children, source of drinking water, and education level of mother seems to have association with infection of the parasite. Genotyping results show that C. parvum is the only species involved in transmission. Conclusion: Cryptosporidium parvum is the commonest enteric parasite causing diarrhoea among children with acute diarrhoea. Children ≤ 3 years and those who drank sachet water were most affected. A carefully planned health education among illiterate mothers and improved sanitary conditions could reduce rate of infections. Further sub-genotyping of C. parvum is needed to determine whether source of infection is zoonotic or anthroponotic.

Molecular characterization of Cryptosporidium and Giardia in farmers and their ruminant livestock from the Coastal Savannah zone of Ghana

“…parvumonly (Anim-Baidoo et al, 2015), while both C. parvum (42.1%) and C. hominis (58.0%) were identified in Cryptosporidium-positive children from the Ashanti Region (outside the present study area) (Eibach et al, 2015). In the latter study, C. parvum (IIc, IIe) and C. hominis (Ia, Ib, Id and Ie) gp60 subtype families were identified, with subtypes IIcA5G3q, IbA13G3 and IaA21R3, being the most frequent (Eibach et al, 2015).…”

“…Squire and Ryan, 2017). Little however, is known about the molecular epidemiology of these diseases in humans and livestock in Ghana, with genotyping studies to date confined to children (Anim-Baidoo et al, 2015;Eibach et al, 2015;Anim-Baidoo et al, 2016). Therefore, the aim of the present study was to determine the species and subtypes of Cryptosporidium and Giardia infecting farmers and their ruminant livestock in Ghana to better understand the transmission dynamics of these parasites in this country.…”

Cryptosporidium and Giardia in Africa: current and future challenges

“…Genotyping of Cryptosporidium species in Africa have identified at least 13 species and genotypes in humans including C. hominis , C. parvum , C. meleagridis, C. ubiquitum , C. viatorum , C. andersoni , C. bovis , C. canis , C. cuniculus , C. felis , C. muris , C. suis and C. xiaoi [ 23 , 25 , 26 , 86 , 97 , 101 , 102 , 115 , 139 – 142 ] (see Table 2 ).…”

“…Cryptosporidium meleagridis was identified in both turkeys and chickens [ 93 , 178 ] and C. baileyi has been identified in chickens [ 93 ]. All the species reported in domesticated animals, except for C. ryanae and C. baileyi , have been identified in humans from Africa [ 23 , 25 , 26 , 97 , 101 , 102 , 115 , 139 – 142 ] (see Table 2 ), suggesting that domestic animals may act as zoonotic reservoirs for human infections. Humans working closely with farmed animals especially calves are known to be more at risk of zoonotic infection with C. parvum and may excrete oocysts without showing clinical symptoms and act as a source of infection for household members [ 118 ].…”

Cryptosporidium Infection and Associated Risk Factors among Cattle in the Central Region of Ghana

“…This method is however laborious, time-consuming, of low sensitivity and requires the expertise of experienced microscopists. Only a handful of studies have utilized enzyme-linked immunosorbent assay (ELISA) for the detection of Cryptosporidium antigens in stool samples in Ghana [ 18 ]. The ELISA method, although expensive, is known to have better sensitivity compared to microscopy and relatively faster as many samples can be processed within a shorter time frame [ 19 – 21 ].…”