Volume 79, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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, cases passed greater number of watery stools ( < 0.05), suffered more episodes of diarrhea ( ≤ 0.05), and were more likely to experience tenesmus ( ≤ 0.05) compared with bacterial causes of TD. ELISA detected seven (3%) cases of , whereas PCR identified an additional seven cases (6%). Speciation by 18SrRNA sequencing showed that 13 cases were caused by and only 1 case was caused by . ELISA showed a sensitivity of 50% and specificity of 100% compared with PCR.


Article metrics loading...

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

Full text loading...



  1. Wolfe MS, 1990. Acute diarrhea associated with travel. Am J Med 88 : 34S–37S. [Google Scholar]
  2. Hill DR, 2000. Occurrence, and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries. Am J Trop Med Hyg 62: 585–589. [Google Scholar]
  3. Yoder JS, Beach MJ, Centers for Disease Control, and Prevention, 2007. Cryptosporidiosis surveillance—United states, 2003–2005. MMWR 56: 1–10. [Google Scholar]
  4. Chappell CL, Okhuysen PC, 2002. Cryptosporidiosis. Curr Opin Infect Dis 15: 523–527. [Google Scholar]
  5. Hashmey R, Genta RM, White AC Jr, 1997. Parasites and diarrhea. I: Protozoans and diarrhea. J Travel Med 4: 17–31. [Google Scholar]
  6. Parisi MT, Tierno PT, 1995. Evaluation of new rapid commercial enzyme immunoassay for detection of Cryptosporidium oocysts in untreated stool specimens. J Clin Microbiol 33: 1963–1965. [Google Scholar]
  7. Marques FR, Cardoso LV, Cavasini CE, Almeida MC, Bassi NA, Almeida MT, Rossit AR, Machado RL, 2005. Performance of an immunoenzymatic assay for Cryptosporidium diagnosis of fecal samples. Braz J Infect Dis 9: 3–5. [Google Scholar]
  8. Morgan UM, Pallant L, Dwyer BW, Forbes DA, Rich G, Thompson RC, 1998. Comparison of PCR, and microscopy for detection of Cryptosporidium parvum in human fecal specimens: Clinical trial. J Clin Microbiol 36: 995–998. [Google Scholar]
  9. Balatbat AB, Jordan GW, Tang YJ, Silva J Jr, 1996. Detection of Cryptosporidium parvum DNA in human feces by nested PCR. J Clin Microbiol 34: 1769–1772. [Google Scholar]
  10. Kehl KS, Cicirello H, Havens PL, 1995. Comparison of four different methods for detection of Cryptosporidium species. J Clin Microbiol 33: 416–418. [Google Scholar]
  11. Bialek R, Binder N, Dietz K, Joachim A, Knobloch J, Zelck UE, 2002. Comparison of fluorescence, antigen, and PCR assays to detect Cryptosporidium parvum in fecal specimens. Diag Microbiol Infect Dis 43: 283–288. [Google Scholar]
  12. Zhu G, Marchewka MJ, Ennis JG, Keithly JS, 1998. Direct isolation of DNA from patient stools for polymerase chain reaction detection of Cryptosporidium parvum. J Infect Dis 177: 1443–1446. [Google Scholar]
  13. Miller WA, Gardner IA, Atwill ER, Leutenegger CM, Miller MA, Hedrick RP, Melli AC, Barnes NM, Conrad PA, 2006. Evaluation of methods for improved detection of Cryptosporidium spp. in mussels (Mytilus californianus). J Microbiol Methods 65: 367–379. [Google Scholar]
  14. Sanchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sanchez D, Malagon F, Rodriguez-Covarrubias JA, Ordonez-Martinez J, Calderon-Romero L, 2006. cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City. Am J Trop Med Hyg 75: 1095–1098. [Google Scholar]
  15. Javier Enriquez F, 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]
  16. Solorzano-Santos F, Penagos-Paniagua M, Meneses-Esquivel R, Miranda-Novales MG, Leanos-Miranda B, Angulo-Gonzalez D, Fajardo-Gutierrez A, 2000. Cryptosporidium parvum infection in malnourished and non malnourished children without diarrhea in a Mexican rural population. Rev Invest Clin 52: 625–631. [Google Scholar]
  17. Bouckenooghe AR, Jiang ZD, De La Cabada FJ, Ericsson CD, DuPont HL, 2002. Enterotoxigenic Escherichia coli as cause of diarrhea among Mexican adults and US travelers in Mexico. J Travel Med 9: 137–140. [Google Scholar]
  18. Taylor DN, Bourgeois AL, Ericsson CD, Steffen R, Jiang ZD, Halpern J, Haake R, Dupont HL, 2006. A randomized, double-blind, multicenter study of rifaximin compared with placebo and with ciprofloxacin in the treatment of travelers’ diarrhea. Am J Trop Med Hyg 74: 1060–1066. [Google Scholar]
  19. Mac Kenzie WR, Hoxie NJ, Proctor ME, Gradus MS, Blair KA, Peterson DE, Kazmierczak JJ, Addiss DG, Fox KR, Rose JB, 1994. A massive out break in Milwaukee of Cryptospridium infection transmitted through the public water supply. N Engl J Med 331: 161–167. [Google Scholar]
  20. Weitzel T, Wichmann O, Muhlberger N, Reuter B, Hoof HD, Jelinek T, 2006. Epidemiological, and clinical features of travel-associated cryptosporidiosis. Clin Microbiol Inf 12: 921–924. [Google Scholar]
  21. Mohamed JA, DuPont HL, Jiang ZD, Belkind–Gerson J, Figueroa JF, Armitige LY, Tsai A, Nair P, Martinez–Sandoval FJ, Guo DC, Hayes P, Okhuysen PC, 2007. A novel single–nucleotide polymorphism in the lactoferrin gene is associated with susceptibility to diarrhea in North American travelers to Mexico. Clin Infect Dis 44: 945–952. [Google Scholar]
  22. DuPont HL, Chappell CL, Sterling CR, Okhuysen PC, Rose JB, Jakubowski W, 1995. The infectivity of Cryptosporidium parvum in healthy volunteers. N Engl J Med 332: 855–859. [Google Scholar]
  23. Chappell CL, Okhuysen PC, Sterling CR, DuPont HL, 1996. Cryptosporidium parvum: Intensity of infection, and oocyst excretion patterns in healthy volunteers. J Infect Dis 173: 232–236. [Google Scholar]
  24. Okhuysen PC, Chappell CL, Crabb JH, Sterling CR, DuPont HL, 1999. Virulence of three distinct Cryptosporidium parvum isolates for healthy adults. J Infect Dis 180: 1275–1281. [Google Scholar]
  25. Llorente MT, Clavel A, Goñi MP, Varea M, Seral C, Becerril R, Suarez L, Gómez–Lus R, 2007. Genetic characterization of Cryptosporidium species from humans in Spain. Parasitol Int 56: 201–205. [Google Scholar]
  26. Xiao L, Ryan UM, 2004. Cryptosporidiosis: an update in molecular epidemiology. Curr Opin Infect Dis 17: 483–490. [Google Scholar]
  27. Alves M, Xiao L, Sulaiman I, 2003. Subgenotype analysis of Cryptosporidium isolates from humans, cattle, and zoo ruminants in Portugal. J Clin Microbiol 41: 2744–2747. [Google Scholar]
  28. McLauchlin J, Amar C, Pedraza–Diaz S, Nichols GL, 2000. Molecular epidemiological analysis of Cryptosporidium spp. in the United Kingdom: results of genotyping Cryptosporidium spp. in 1,705 fecal samples from humans, and 105 fecal samples from livestock animals. J Clin Microbiol 38: 3984–3990. [Google Scholar]
  29. Fretz R, Svoboda P, Ryan UM, 2003. Genotyping of Cryptosporidium spp. isolated from human stool samples in Switzerland. Epidemiol Infect 131: 663–667. [Google Scholar]
  30. Tiangtip R, Jongwutiwes S, 2002. Molecular analysis of Cryptosporidium species isolated from HIV–infected patients in Thailand. Trop Med Int Health 7: 357–364. [Google Scholar]
  31. Yagita K, Izumiyama S, Tachibana H, Masuda G, Iseki M, Furuya K, Kameoka Y, Kuroki T, Itagaki T, Endo T, 2001. Molecular characterization of Cryptosporidium isolates obtained from human, and bovine infections in Japan. Parasitol Res 87: 950–955. [Google Scholar]
  32. Nichols RA, Campbell BM, Smith HV, 2003. Identification of Cryptosporidium spp. oocysts in United Kingdom noncarbonated natural mineral waters, and drinking waters by using a modified nested PCR–restriction fragment length polymorphism assay. Appl Environ Microbiol 69: 4183–4189. [Google Scholar]
  33. Learmonth JJ, Ionas G, Pita AB, Cowie RS, 2003. Identification and genetic characterization of Giardia, and Cryptosporidium strains in humans, and dairy cattle in the Waikato Region of New Zealand. Water Sci Technol 47: 21–26. [Google Scholar]
  34. Cama VA, Bern C, Sulaiman IM, Gilman RH, Ticona E, Vivar A, Kawai V, Vargas D, Zhou L, Xiao L, 2003. Cryptosporidium species and genotypes in HIV-positive patients in Lima, Peru. J Eukaryot Microbiol 50: 531–533. [Google Scholar]
  35. 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]
  36. Bushen OY, Kohli A, Pinkerton RC, Dupnik K, Newman RD, Sears CL, Fayer R, Lima AA, Guerrant RL, 2007. Heavy cryptosporidial infections in children in northeast Brazil: Comparison of Cryptosporidium hominis, and Cryptosporidium parvum. Trans R Soc Trop Med Hyg 101: 378–384. [Google Scholar]
  37. Gatei W, Greensill J, Ashford RW, Cuevas LE, Parry CM, Cunliffe NA, Beeching NJ, Hart CA, 2003. Molecular analysis of the 18S rRNA gene of Cryptosporidium parasites from patients with or without human immunodeficiency virus infections living in Kenya, Malawi, Brazil, the United Kingdom, and Vietnam. J Clin Microbiol 41: 1458–1462. [Google Scholar]
  38. Di Giovanni GD, Betancourt WQ, Hernandez J, Assadian NW, Flores Margez JP, Lopez EJ, 2006. Investigation of potential zooanthroponotic transmission of cryptosporidiosis, and giardiasis through agricultural use of reclaimed wastewater. Int J Environ Health Res 16: 405–418. [Google Scholar]
  39. Gasser RB, El–Osta YG, Chalmers RM, 2003. Electrophoretic analysis of genetic variability within Cryptosporidium parvum from imported, and autochthonous cases of human cryptosporidiosis in the United Kingdom. Appl Environ Microbiol 69: 2719–2730. [Google Scholar]
  40. Warren KS, Swan RA, Morgan–Ryan UM, 2003. Cryptosporidium muris infection in bilbies (Macrotis lagotis). Aust Vet J 81: 739–741. [Google Scholar]
  41. Fayer R, Morgan U, Upton SJ, 2000. Epidemiology of Cryptosporidium: Transmission, detection, and identification. Int J Parasitol 30: 1305–1322. [Google Scholar]
  42. Kostrzynska M, Sankey M, Haack E, Power C, Aldom JE, Chagla AH, Unger S, Palmateer G, Lee H, Trevors JT, De Grandis SA, 1999. Three sample preparation protocols for polymerase chain reaction based detection of Cryptosporidium parvum in environmental samples. J Microbiol Methods 35: 65–71. [Google Scholar]
  43. Mayer CL, Palmer CJ, 1996. Evaluation of PCR, nested PCR and fluorescent antibodies for detection of Giardia, and Cryptosporidium species in wastewater. Appl Environ Microbiol 62: 2081–2085. [Google Scholar]
  44. Sturbaum GD, Reed C, Hoover PJ, Jost BH, Marshall MM, Sterling CR, 2001. Species–specific, nested PCR–restriction fragment length polymorphism detection of single Cryptosporidium parvum oocysts. Appl Environ Microbiol 67: 2665–2668. [Google Scholar]

Data & Media loading...

  • Received : 05 Nov 2007
  • Accepted : 30 May 2008

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