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CRYPTOSPORIDIOSIS AMONG BANGLADESHI CHILDREN WITH DIARRHEA: A PROSPECTIVE, MATCHED, CASE-CONTROL STUDY OF CLINICAL FEATURES, EPIDEMIOLOGY AND SYSTEMIC ANTIBODY RESPONSES

We conducted a prospective case-control study to investigate the epidemiology, clinical features, and systemic antibody responses of cryptosporidiosis in Bangladeshi children. Forty-six children presenting to the International Center for Diarrheal Disease Research, Bangladesh in Dhaka, Bangladesh with diarrhea and Cryptosporidium spp. oocysts in the stool were enrolled as cases. Forty-six age-matched children with diarrhea, but without cryptosporidial infection, were enrolled as controls. Thirty cases and 23 controls returned for follow-up three weeks after discharge. Infection with Cryptosporidium spp. occurred most commonly in those less than two years of age, was accompanied by watery diarrhea and vomiting, and was more likely to be associated with persistent diarrhea. Other than duration of diarrhea, there were no significant differences in clinical or epidemiologic features between cases and controls. Cryptosporidium-specific serum IgM levels were significantly higher in cases compared with controls at presentation. In addition, there was a significant increase in serum Cryptosporidium-specific serum IgG levels over the three-week follow-up period in cases compared with controls. Within the case group, there was no difference between children with acute and persistent diarrhea in the change in IgG levels over the follow-up period. However, there was a significant difference between children with acute and persistent diarrhea in changes in both IgA and IgM levels, with persistent diarrhea being associated with a decrease in levels of both antibodies.

Received September 22, 2003. Accepted for publication May 21, 2004.

Acknowledgments: We thank Hosne Ara Shova, Humayun Kabir, the staff of the hospital surveillance system, and the nurses and staff of the clinical study ward of the ICDDR, B for assistance with the study and care of the patients. We also thank Roberta O’Connor, Brett Leav, and Meera Chhagan for critical reading of the manuscript.

Financial support: This study was supported by International Collaborations in Infectious Diseases Research grants AI-45508 and AI-58935 and by an opportunity pool grant from the International Centers for Tropical Diseases Research of the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH). Kathleen A. Rogers is supported by training grant A-I07389 from the NIH.

^* These authors contributed equally to this study.

Authors’ addresses: Wasif A. Khan, Mohammad Mahbubul Karim, and Sabeena Ahmed, Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh, Telephone: 880-2-988-6734, Fax: 880-2-882-3116, E-mails: wakhan{at}icddrb.org, mahbubul{at}icddrb.org, and asabeena{at}hotmail.com. Kathleen A. Rogers, Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts-New England Medical Center, Box 041, 750 Washington Street, Boston, MA 02111, Telephone: 617-636-8437, Fax: 617-636-5292, E-mail: krogers{at}tufts-nemc.org. Patricia L. Hibberd, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Department of Medicine, Tufts-New England Medical Center, Box 041, 750 Washington Street, Boston, MA 02111, Telephone: 617-636-2215, Fax: 617-636-5560, E-mail: phibberd{at}tufts-nemc.org. Stephen B. Calderwood, Division of Infectious Diseases, Massachusetts General Hospital, Jackson 504, 55 Fruit Street, Boston, MA 02114, Telephone: 617-726-3811, Fax: 617-726-7416, E-mail: scalderwood{at}partners.org. Edward T. Ryan, Division of Infectious Diseases, Massachusetts General Hospital, Jackson 504, 55 Fruit Street, Boston, MA 02114, Telephone: 617-726-6175, Fax: 617-726-7416, E-mail: etryan{at}partners.org. Honorine D. Ward, Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts-New England Medical Center, Box 041, 750 Washington Street, Boston, MA 02111, Telephone: 617-636-7032 Fax: 617-636-5292, E-mail: hward{at}tufts-nemc.org.

Reprint requests: Honorine D. Ward, Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts-New England Medical Center, Box 041, 750 Washington Street, Boston, MA 02111.

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