Volume 68, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


A cross-sectional case-control study (ratio = 3:1) was conducted over a 15-month period to determine the prevalence and consequences of cryptosporidiosis in hospitalized diarrheic children (0–5 years old) at Mulago Hospital in Kampala, Uganda. was detected and genotyped among 2,446 children of whom 1,779 (72.7%) had diarrhea, and 667 (27.3%) were age- and sex-matched controls. Of the 1,779 children with diarrhea, 532 (29.9%) had persistent (> 14 days) diarrhea and 1,247 (70.1%) had acute diarrhea. Overall, 444 (25.0%) of the 1,779 children with diarrhea had , compared with only 57 (8.5%) of the 667 children without diarrhea (χ = 80.2, ≤ 0.0001). Within this group of infected children, 72.8% were infected with genotype 1, 18.4% with genotype 2, and 4.1% with a mixture of both genotypes, and 4.1% isolates were either unclassified or . The prevalence was highest during the rainy months of April to June. Of the 532 children with persistent diarrhea, 166 (31.2%) had compared with 278 (22.3%) of the 1,247 children with acute diarrhea (χ = 15.8, ≤ 0.0001). There was a significant association between and malnutrition including stunting, being underweight, and wasting. Unfavorable outcome (death or failure to resolve within 14 days) occurred in 139 (72.8%) of the 191 children with , and in only 65.1% of the 545 without (odds ratio = 1.117, 95% confidence interval = 1.005–1.243, = 0.05), Of the 191 children with , 24 (12.6%) died, compared with 34 (6.2%) of the 545 without ( = 0.005). Mortality rates were higher among children with severe dehydration and persistent diarrhea, and in stunted or underweight children infected with . Among Ugandan children, cryptosporidiosis, which remains untreatable, is frequently associated with diarrhea and other serious and unfavorable consequences.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Anonymous, 1996. Ominous trends for infectious diseases (editorial). Science 272 : 1269. [Google Scholar]
  2. Sazawal S, Bhan MK, Bhandari N, Clemens J, Bhatnagar S, 1991. Evidence for recent diarrhoeal morbidity as a risk factor for persistent diarrhoea: a case-control study. Int J Epidemiol 20 : 540–545. [Google Scholar]
  3. Anonymous, 1998. Persistent diarrhoea in children in developing countries: memorandum from a WHO meeting. Bull World Health Organ 66 : 709–717. [Google Scholar]
  4. Faveau V, Henry FJ, Briend A, Yunus M, Chakraborty JP, 1992. Persistent diarrhea as a cause of childhood mortality in rural Bangladesh. Acta Paediatr Scand 81 (Suppl 381) : 12–24. [Google Scholar]
  5. Victoria CG, Huttly SR, FuchsSC, Nobre LC, Barros FC, 1992. Deaths due to dysentery, acute and persistent diarrhea among Brazilian infants. Acta Paediatr Scand 81 (Suppl 381) : 7–11. [Google Scholar]
  6. Kikafunda JK, Walker AF, Allan F, Collet D, Tumwine JK, 1998. Risk factors for early childhood malnutrition in Uganda. Pediatrics 10 : 45–53. [Google Scholar]
  7. Griffiths JK, 1998. Human cryptosporidiosis: epidemiology, transmission, clinical disease treatment, and diagnosis. Adv Parasitol 40 : 38–87. [Google Scholar]
  8. Rossignol JF, Ayoub A, Ayers MS, 2001. Treatment of diarrhea caused by Cryptosporidium: a prospective randomized double-blind placebo controlled study of nitazoxanide. J Infect Dis 184 : 103–106. [Google Scholar]
  9. Amadi B, Mwiya M, Musuku J, Watuka A, Sianongo S, Ayoub A, Kelly P, 2002. Effect of nitazoxanide on morbidity and mortality in Zambian children with cryptosporidiosis: a randomized controlled trial. Lancet 360 : 1375–1380. [Google Scholar]
  10. Kish L, 1965. Survey Sampling. New York: John Wiley and Sons.
  11. Nchito M, Kelly P, Sianongo S, Luo NP, Feldman R, Farthing M, Baboo KS, 1988. Cryptosporidiosis in urban Zambian children: an analysis of risk factors. Am J Trop Med Hyg 59 : 435–437. [Google Scholar]
  12. Fleiss JL, 1981. Statistical Methods for Rates and Proportions. Second edition. New York: John Wiley and Sons.
  13. Guerrant RL, 1997. Cryptosporidiosis: an emerging, highly infectious threat. Emerg Infect Dis 3 : 51–57. [Google Scholar]
  14. United Nations, 1986. How to Weigh and Measure Children: Assessing the Nutritional Status of Young Children in Household Surveys. New York: United Nations.
  15. Spano F, Putignani L, Cristanti A, Sallicandro P, Morgan UM, LeBlancq SM, Tchack L, Tzipori S, Widmer G, 1998. Multilocus genotypic analysis of Cryptosporidium parvum isolates from different hosts and geographical origins. J Clin Microbiol 36 : 3255–3259. [Google Scholar]
  16. Tumwine JK, Kekitiinwa A, Nabukeera N, Akiyoshi DE, Buckholt MA, Tzipori S, 2002. Enterocytozoon bieneusi among children with diarrhea attending Mulago Hospital, Uganda. Am J Trop Med Hyg 67 : 290–303. [Google Scholar]
  17. Dean AG, Dean JA, Coulombier D, 1997. Epi-Info. Version 6.0. A Word Processing Database and Statistics Program for Public Health on IBM Compatible Microcomputers. Atlanta: Centers for Disease Control and Prevention.
  18. Akyon Y, Erguven S, Arikan S, Yurdakok K, Gunalp A, 1999. Cryptosporidium parvum prevalence in a group of Turkish children. Turk J Pediatr 41 : 189–196. [Google Scholar]
  19. Nacro B, Bonkoungou P, Nagalo K, Tall FR, Curtis V, 1998. Clinical profile of cryptosporidiosis in a pediatric hospital environment in Burkina Faso. Med Trop (Mars) 58 : 47–50. [Google Scholar]
  20. Feng X, Rich SM, Akiyoshi D, Tumwine JK, Kekitiinwa A, Nabukeera N, Tzipori S, Widmer G, 2000. Extensive polymorphism in Cryptosporidium parvum identified by multilocus microsatellite analysis. Appl Environ Microbiol 66 : 3344–3349. [Google Scholar]
  21. Fripp PJ, Bothma MT, Crewe-Brown HH, 1991. Four years of cryptosporidiosis at GaRunkwa Hospital. J Infect 23 : 93–100. [Google Scholar]
  22. Okafor JI, Okunji PO, 1996. Prevalence of Cryptosporidium oocysts in fecal samples of some school children in Enugu State, Nigeria. J Commun Dis 28 : 49–55. [Google Scholar]
  23. Molbak K, Andersen M, Aaby P, Hojlyng N, Jakobsen M, Sodemann M, da Silva AP, 1997. Cryptosporidium infection in infancy as a cause of malnutrition: a community study from Guinea-Bissau, west Africa. Am J Clin Nutr 65 : 149–152. [Google Scholar]
  24. Enriquez J, Avila CR, Ignacio Santos J, Tanaka-Kido J, Vallejo O, Sterling CR, 1997. Cryptosporidium infections in Mexican children: clinical, nutritional, enteropathogenic, and diagnostic evaluations. Am J Trop Med Hyg 56 : 254–257. [Google Scholar]
  25. Checkley W, Gilman RH, Epstein LD, Suarez M, Diaz JF, Cabrera L, Black RE, Sterling CR, 1997. Asymptomatic and symptomatic cryptosporidiosis: their acute effect on weight gain in Peruvian children. Am J Epidemiol 145 : 156–163. [Google Scholar]
  26. Lima AA, Moore SR, Barboza MS Jr, Soares AM, Schleupner MA, New RD, Sear CL, Nataro JP, Fedorko DP, Wuhib T, Schorling JB, Guerrant RL, 2000. Persistent diarrhea signals a critical period of increased diarrhea burden and nutritional shortfalls: a prospective cohort study among children in northeastern Brazil. J Infect Dis 181 : 1643–1651. [Google Scholar]
  27. Niehaus MD, Moore SR, Patrick PD, Derr LL, Lorntz B, Lima AA, Guerrant RL, 2002. Early childhood is associated with diminished cognitive function 4 to 7 years later in children in a northeast Brazilian shantytown. Am J Trop Med Hyg 66 : 590–593. [Google Scholar]
  28. Akiyoshi DE, Dilo J, Pearson C, Chapman S, Tumwine J, Tzipori S, 2002. Characterization of Cryptosporidium meleagridis of human origin passaged through different host species. Infect Immun 71 : 1828–1832. [Google Scholar]
  29. Pieniazek NJ, Bornay-Llinares FJ, Slemenda SB, da Silva AJ, Moura IN, Arrowood MJ, Ditrich O, Addiss DG, 1999. New Cryptosporidium genotypes in HIV-infected persons. Emerg Infect Dis 5 : 444–449. [Google Scholar]
  30. Morgan U, Weber R, Xiao L, Sulaiman I, Thompson RC, Ndiritu W, Lal A, Moore A, Deplazes P, 2000. Molecular characterization of Cryptosporidium isolates obtained from human immunodeficiency virus-infected individuals living in Switzerland, Kenya and the United States. J Clin Microbiol 38 : 1180–1183. [Google Scholar]
  31. Xiao L, Bern C, Limor J, Sulaiman I, Roberts J, Checkley W, Cabrera L, Gilman RH, Lal AA, 2001. Identification of 5 types of Cryptosporidium parasites in children in Lima, Peru. J Infect Dis 183 : 492–497. [Google Scholar]

Data & Media loading...

  • Received : 20 Sep 2002
  • Accepted : 03 Mar 2003

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error