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Epidemiology of Cryptosporidiosis in North American Travelers to Mexico

We studied 1,179 North American travelers who visited Mexico from 2005 to 2007. Travelers’ diarrhea (TD) was reported by 521 (44%) participants. Among subjects with TD, 218 cases were examined for cryptosporidiosis by polymerase chain reaction (PCR) and enzyme-linked immunoassays (ELISA). There were 14 (6%) cases of cryptosporidiosis and 141 cases (64%) of bacterial diarrhea. Compared with bacterial diarrhea, a longer stay in Mexico was a risk factor for cryptosporidiosis. Additionally, Cryptosporidium cases passed greater number of watery stools (P < 0.05), suffered more episodes of diarrhea (P 0.05), and were more likely to experience tenesmus (P 0.05) compared with bacterial causes of TD. ELISA detected seven (3%) cases of Cryptosporidium, whereas PCR identified an additional seven cases (6%). Speciation by 18SrRNA sequencing showed that 13 cases were caused by C. parvum and only 1 case was caused by C. hominis. ELISA showed a sensitivity of 50% and specificity of 100% compared with PCR.

Received November 5, 2007. Accepted for publication May 30, 2008.

Acknowledgments: We thank Dorothy Ruelas, RN, Judy Guillen, RN, Margaret DuPont, MS, Jackie Vaca, RN, and the administration and staff of Universidad Internacional in Cuernavaca, Morelos, for assistance with this project.

Financial support: This work was supported by the following sources: NIHDMID R01 AI54948–01 (PCO), to the Center for Clinical and Translational Sciences of the University of Texas Health Science Center at Houston, NIHNCRR ULIRR024148 (CTSA), of the University of Texas Medical School at Houston, and DK56338, which funds the Texas Gulf Coast Digestive Diseases Center.

Disclosure: The authors report that there are no conflicts of interest related to this work.

^* Address correspondence to Pablo C. Okhuysen, Division of Infectious Diseases, The University of Texas Medical School, 6431 Fannin Street, MSB 2.112, Houston, TX 77030. E-mail: Pablo.c.okhuysen{at}uth.tmc.edu

Presented in part at the Annual Meeting of the Infectious Diseases Society of America (IDSA), October 5, 2007, San Diego, CA.

Authors’ addresses: Parvathy Nair, Jamal A. Mohamed, Jose Flores Figueroa, and Lily G. Carlin, 6431 Fannin, MSB 7.510, Houston, TX 77030. Herbert L. DuPont and Zhi-Dong Jiang, 1200 Hermann Pressler Dr., Houston, TX 77030. Jaime Belkind-Gerson, Av. Universidad #655, Col. Santa maria Ahauacatitlan CP 62508, Cuernavaca, Morelos, Mexico. Francisco G. Martinez-Sandoval, Av. Patria 1201, Lomas del Valle, 3^a seccion, Apartado postal 1 440, CP 44100, Guadalajara, Jalisco, Mexico. Pablo C. Okhuysen, Division of Infectious Diseases, The University of Texas Medical School, 6431 Fannin Street, MSB 2.112, Houston, TX 77030, Tel: 713-500-6736, Fax: 713-500-5495, E-mail: Pablo.c.okhuysen{at}uth.tmc.edu.

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