Distribution and Clinical Manifestations of Cryptosporidium Species and Subtypes in HIV/AIDS Patients in Ethiopia

Abstract

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.

Cryptosporidium species and subtypes in diarrheal children and HIV-infected persons in Ebonyi and Nsukka, Nigeria

“…Similarly, 2 C. parvum subtypes (IIcA5G3b and IIcA5G3k) and 1 C. hominis subtype (IaA29R3) were among the small number of Cryptosporidium-positive specimens from HIV-infected persons in Nsukka. The high diversity of Cryptosporidium subtypes observed in this study is consistent with previous studies in western Nigeria and other African countries [5,6,8,10,11]. Some of the subtypes seen in this study, such as C. hominis subtypes IeA11G3T3, IbA13G3, IbA10G2, and IaA25R3 and C. parvum subtypes IIcA5G3b and IIcA5G3k, have been reported in studies conducted in Benin city, Edo, midwestern Nigeria and Oyo state, southwestern Nigeria [6,8,10].…”

“…Cryptosporidium infections in children and immune-compromised individuals such as HIVinfected persons have been reported from many parts of the world, including southwestern and midwestern Nigeria [4][5][6]8,10,[14][15][16]. This study was conducted in southeastern Nigeria.…”

“…In this study, HIV-infected persons with CD4 [5,6] from similar studies conducted in western Nigeria and Ethiopia, respectively. In this study, however, one of the HIV-infected persons, with CD4 + cell count of 542 cells/mm 3 , was infected with Cryptosporidium.…”

“…The parasite can be zoonotic or anthroponotic in origin and has been implicated in diarrhea outbreaks in different parts of the world [3][4][5]. Infections in HIV + patients have been associated with low CD4 + cell counts (< 200 cells/mm 3 ), lack of access to highly active antiretroviral therapy (HAART), and poor hygiene, while infections in children are associated mostly with young age and poor hygiene [4,6,7].…”

Occurrence and molecular characterization of Cryptosporidium sp. in sheep

“…The first report of C. xiaoi in humans was in patients with HIV/AIDS in Ethiopia (ADAMU et al, 2014), where sheep may have been an important source for spreading this parasite to the human population; there is constant and periodic contact of feeders with the animals and possible sources of disease transmission such as water and food.…”