Cryptosporidium infections in Sweden—understanding the regional differences in reported incidence

Harvala, Heli; Ögren, Jessica; Boman, P.; Riedel, Hilde M.; Nilsson, Peter; Winiecka-Krusnell, Jadwiga; Beser, Jessica

doi:10.1016/j.cmi.2016.09.012

Cited by 6 publications

(9 citation statements)

References 4 publications

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“…An infection with Cryptosporidium can cause watery diarrhea and abdominal pain, sometimes fever and vomiting. Cryptosporidiosis lasts longer (usually more than 10 days) than most episodes of gastroenteritis caused by viruses and bacteria [2,4]. Cryptosporidium infection can lead to serious illness with prolonged diarrhea and extra-intestinal manifestations in immunocompromised patients [2].…”

Section: Introductionmentioning

confidence: 99%

Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms

Ögren

Dienus

Beser

et al. 2020

Eur J Clin Microbiol Infect Dis

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In acute gastroenteritis (GE), identification of the infectious agent is important for patient management and surveillance. The prevalence of GE caused by protozoa may be underestimated in Swedish patients. The purpose was to compare the prevalence of E. histolytica, Cryptosporidium spp., G. intestinalis, and C. cayetanensis in samples from patients where the clinician had requested testing for gastrointestinal parasites only (n = 758) to where testing for bacterial GE only (n = 803) or where both parasite and bacterial testing (n = 1259) was requested and a healthy control group (n = 197). This prospective cohort study was conducted in Region Jönköping County, Sweden (October 2018–March 2019). Fecal samples were analyzed with microscopy and real-time PCR. Cryptosporidium spp. was detected in 16 patients in the bacterial GE group and in 13 in the both bacterial and parasite group; no cases were detected in the group were only parasite infection was suspected. C. cayetanensis was detected in two patients in the bacterial GE group. One case of E. histolytica was detected in the bacterial group and one in the both bacterial and parasite group. G. intestinalis was detected in 14 patients in the parasite only group, 12 in the both parasite and bacterial group, three in the bacterial GE group, and one in the control group. Diarrhea caused by protozoa, especially Cryptosporidium was under–recognized by clinicians and is likely more common than hitherto estimated in Sweden. A more symptom-based diagnostic algorithm may increase detection and knowledge about protozoan infections.

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Section: Introductionmentioning

confidence: 99%

Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms

Ögren

Dienus

Beser

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…Training in appearance of Cryptosporidium in wet mounts is not commonly included in basic training, but we can show here that if it is, it can increase detection. It has been part of basic training here for more than a decade and the incidence in this region is among the highest incidences of Cryptosporidium in Sweden [7]. All suspected wet mount findings are verified with Z-N.…”

Section: Discussionmentioning

confidence: 87%

“…Cryptosporidium spp. is one of the most important protozoan infections in Sweden and detection is necessary to determine the true incidence, learn more about the burden of this infection and to prevent secondary transmissions and outbreaks [7,46]. In this study, the routine microscopy method included staining for Cryptosporidium when requested and no extended wet mount screening was done.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the routine microscopy method included staining for Cryptosporidium when requested and no extended wet mount screening was done. Some laboratories in Sweden use wet mount screening and some do not [7] and in this study we chose to compare our extended method with no wet mount screening for Cryptosporidium. In the present study Cryptosporidium was requested during a known small outbreak and only very sporadically on other symptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

“…Cryptosporidium can cause severe symptoms in immunocompromised patients and a fast diagnosis is important to prevent complications [6]. However, clinical awareness is generally low, resulting in few requests [7][8][9][10]. In Sweden, the reported incidences of Cryptosporidium vary, and a recent study suggests both diagnostic methods and testing algorithm to be the cause [7].…”

Section: Introduction/backgroundmentioning

confidence: 99%

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Optimization of routine microscopic and molecular detection of parasitic protozoa in SAF-fixed faecal samples in Sweden

Ögren

Dienus

Matussek

2019

Infectious Diseases

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Background: Nucleic acid-based methods are increasingly used for screening of gastrointestinal parasites. Microscopy is still used and Swedish routine protocol consists of formalin ethyl-acetate concentration and do not include screening for trophozoites or Cryptosporidium spp. This study aimed to compare detection with the Swedish routine microscopy method to an extended method that includes screening for trophozoites and Cryptosporidium. Furthermore, we also developed a method for DNA recovery from SAF-fixed faecal samples and compared the real-time PCR detection of Giardia intestinalis, Dientamoeba fragilis, Cryptosporidium spp., Entamoeba histolytica and Entamoeba dispar from SAF-fixed and unpreserved faecal samples. PCR results were then compared with microscopy results. Methods: SAF-fixed and unpreserved faecal samples from 1000 patients at the Clinical microbiology laboratory in Region J€ onk€ oping County, Sweden, were included. Samples were analysed with routine formalin ethyl-acetate concentration, wet mounts from both concentrated and unconcentrated samples, Ziehl-Neelsen staining on patients with certain symptoms and real-time PCR. Results: We found a significant higher detection rate of parasites with the extended microscopy method compared to the Swedish routine microscopy method when SAF-fixed samples were used. The detection rate with real-time PCR in SAF-fixed samples was equal to the detection rate in unpreserved samples. There was no significant difference in detection comparing extended microscopy and real-time PCR. Conclusion: In conclusion, this study showed that the extended microscopy method increased detection of intestinal protozoa with detection of both trophozoites and Cryptosporidium spp. We also showed that SAF-fixative can be used for detection of parasite-DNA with real-time PCR.

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Use of metagenomic microbial source tracking to investigate the source of a foodborne outbreak of cryptosporidiosis

Ahlinder

Svedberg²,

Nystedt³

et al. 2022

Food and Waterborne Parasitology

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Cryptosporidium is a protozoan parasite of global public health importance that causes gastroenteritis in a variety of vertebrate hosts, with many human outbreaks reported yearly, often from ingestion of contaminated water or food. Despite the major public health implications, little is typically known about sources of contamination of disease outbreaks caused by Cryptosporidium. Here, we study a national foodborne outbreak resulted from infection with Cryptosporidium parvum via romaine lettuce, with the main goal to trace the source of the parasite. To do so, we combined traditional outbreak investigation methods with molecular detection and characterization methods (i.e. PCR based typing, amplicon and shotgun sequencing) of romaine lettuce samples collected at the same farm from which the contaminated food was produced. Using 18S rRNA typing, we detected C. parvum in two out of three lettuce samples, which was supported by detections in the metagenome analysis. Microbial source tracking analysis of the lettuce samples suggested sewage water as a likely source of the contamination, albeit with some uncertainty. In addition, the high degree of overlap in bacterial species content with a public human gut microbial database corroborated the source tracking results. The combination of traditional and molecular based methods applied here is a promising tool for future source tracking investigations of food- and waterborne outbreaks of Cryptosporidium spp. and can help to control and mitigate contamination risks.

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Cryptosporidium infections in Sweden—understanding the regional differences in reported incidence

Cited by 6 publications

References 4 publications

Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms

Protozoan infections are under-recognized in Swedish patients with gastrointestinal symptoms

Optimization of routine microscopic and molecular detection of parasitic protozoa in SAF-fixed faecal samples in Sweden

Use of metagenomic microbial source tracking to investigate the source of a foodborne outbreak of cryptosporidiosis

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