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

WASIF A. KHAN Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Tufts-New England Medical Center, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts

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KATHLEEN A. ROGERS Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Tufts-New England Medical Center, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts

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MOHAMMAD MAHBUBUL KARIM Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Tufts-New England Medical Center, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts

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SABEENA AHMED Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Tufts-New England Medical Center, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts

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PATRICIA L. HIBBERD Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Tufts-New England Medical Center, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts

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STEPHEN B. CALDERWOOD Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Tufts-New England Medical Center, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts

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EDWARD T. RYAN Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Tufts-New England Medical Center, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts

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HONORINE D. WARD Clinical Sciences Division, Centre for Health and Population Research, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh, Divisions of Geographic Medicine and Infectious Diseases and Clinical Care Research, Tufts-New England Medical Center, Boston, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard School of Public Health, Boston, Massachusetts

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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.

Author Notes

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.
  • 1

    Dillingham RA, Lima AA, Guerrant RL, 2002. Cryptosporidiosis: epidemiology and impact. Microbes Infect 4 :1059–1066.

  • 2

    Leav BA, Mackay M, Ward HD, 2003. Cryptosporidium species: new insights and old challenges. Clin Infect Dis 36 :903–908.

  • 3

    Tzipori S, Ward H, 2002. Cryptosporidiosis: biology, pathogenesis and disease. Microbes Infect 4 :1047–1058.

  • 4

    Griffiths JK, 1998. Human cryptosporidiosis: epidemiology, transmission, clinical disease, treatment, and diagnosis. Adv Parasitol 40 :37–85.

  • 5

    Checkley W, Epstein LD, Gilman RH, Black RE, Cabrera L, Sterling CR, 1998. Effects of Cryptosporidium parvum infection in Peruvian children: growth faltering and subsequent catch-up growth. Am J Epidemiol 148 :497–506.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Guerrant DI, Moore SR, Lima AA, Patrick PD, Schorling JB, Guerrant RL, 1999. Association of early childhood diarrhea and cryptosporidiosis with impaired physical fitness and cognitive function four-seven years later in a poor urban community in northeast Brazil. Am J Trop Med Hyg 61 :707–713.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Albert MJ, Faruque AS, Faruque SM, Sack RB, Mahalanabis D, 1999. Case-control study of enteropathogens associated with childhood diarrhea in Dhaka, Bangladesh. J Clin Microbiol 37 :3458–3464.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Bhattacharya MK, Teka T, Faruque AS, Fuchs GJ, 1997. Cryptosporidium infection in children in urban Bangladesh. J Trop Pediatr 43 :282–286.

  • 10

    Rahman M, Shahid NS, Rahman H, Sack DA, Rahman N, Hossain S, 1990. Cryptosporidiosis: a cause of diarrhea in Bangladesh. Am J Trop Med Hyg 42 :127–130.

  • 11

    Shahid NS, Rahman AS, Sanyal SC, 1987. Cryptosporidium as a pathogen for diarrhoea in Bangladesh. Trop Geogr Med 39 :265–270.

  • 12

    Haque R, Mondal D, Kirkpatrick BD, Akther S, Farr BM, Sack RB, Petri WA Jr, 2003. Epidemiologic and clinical characteristics of acute diarrhea with emphasis on Entamoeba histolytica infections in preschool children in an urban slum of Dhaka, Bangladesh. Am J Trop Med Hyg 69 :398–405.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    WHO, 1999. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: World Health Organization.

    • PubMed
    • Export Citation
  • 14

    WHO, 1991. World Health Organization Program for Control of Diarrhoeal Disease, Guidelines for Cholera Control. WHO/CDD/SER/80.4 REV.2. Geneva: World Health Organization.

    • PubMed
    • Export Citation
  • 15

    Perch M, Sodemann M, Jakobsen MS, Valentiner-Branth P, Steinsland H, Fischer TK, Lopes DD, Aaby P, Molbak K, 2001. Seven years’ experience with Cryptosporidium parvum in Guinea-Bissau, west Africa. Ann Trop Paediatr 21 :313–318.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Pereira MD, Atwill ER, Barbosa AP, Silva SA, Garcia-Zapata MT, 2002. Intra-familial and extra-familial risk factors associated with Cryptosporidium parvum infection among children hospitalized for diarrhea in Goiania, Goias, Brazil. Am J Trop Med Hyg 66 :787–793.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Kirkpatrick BD, Daniels MM, Jean SS, Pape JW, Karp C, Littenberg B, Fitzgerald DW, Lederman HM, Nataro JP, Sears CL, 2002. Cryptosporidiosis stimulates an inflammatory intestinal response in malnourished Haitian children. J Infect Dis 186 :94–101.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Molbak K, Hojlyng N, Gottschau A, Sa JC, Ingholt L, da Silva AP, Aaby P, 1993. Cryptosporidiosis in infancy and childhood mortality in Guinea Bissau, west Africa. BMJ 307 :417–420.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Tumwine JK, Kekitiinwa A, Nabukeera N, Akiyoshi DE, Rich SM, Widmer G, Feng X, Tzipori S, 2003. Cryptosporidium parvum in children with diarrhea in Mulago Hospital, Kampala, Uganda. Am J Trop Med Hyg 68 :710–715.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Newman RD, Sears CL, Moore SR, Nataro JP, Wuhib T, Agnew DA, Guerrant RL, Lima AA, 1999. Longitudinal study of Cryptosporidium infection in children in northeastern Brazil. J Infect Dis 180 :167–175.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Molbak K, Aaby P, Hojlyng N, da Silva AP, 1994. Risk factors for Cryptosporidium diarrhea in early childhood: a case-control study from Guinea-Bissau, west Africa. Am J Epidemiol 139 :734–740.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Nchito M, Kelly P, Sianongo S, Luo NP, Feldman R, Farthing M, Baboo KS, 1998. Cryptosporidiosis in urban Zambian children: an analysis of risk factors. Am J Trop Med Hyg 59 :435–437.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Bogaerts J, Lepage P, Rouvroy D, Vandepitte J, 1984. Cryptosporidium spp., a frequent cause of diarrhea in central Africa. J Clin Microbiol 20 :874–876.

  • 25

    Rumi MA, Siddiqui MA, Salam MA, Iqbal MR, Azam MG, Chowdhury AK, Khan AYM, Hasan KN, Hassan MS, 2000. Prevalence of infectious diseases and drug abuse among Bangladeshi workers. Southeast Asian J Trop Med Public Health 31 :571–574.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Rahman AS, Sanyal SC, Al-Mahmud KA, Sobhan A, 1985. Cryptosporidium diarrhoea in calves and their handlers in Bangladesh. Indian J Med Res 82 :510–516.

  • 27

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    McDonald AC, Mac Kenzie WR, Addiss DG, Gradus MS, Linke G, Zembrowski E, Hurd MR, Arrowood MJ, Lammie PJ, Priest JW, 2001. Cryptosporidium parvum-specific antibody responses among children residing in Milwaukee during the 1993 waterborne outbreak. J Infect Dis 183 :1373–1379.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Ungar BL, Mulligan M, Nutman TB, 1989. Serologic evidence of Cryptosporidium infection in US volunteers before and during Peace Corps service in Africa. Arch Intern Med 149 :894–897.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Okhuysen PC, Chappell CL, Sterling CR, Jakubowski W, Du-Pont HL, 1998. Susceptibility and serologic response of healthy adults to reinfection with Cryptosporidium parvum.Infect Immun 66 :441–443.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Priest JW, Li A, Khan M, Arrowood MJ, Lammie PJ, Ong CS, Roberts JM, Isaac-Renton J, 2001. Enzyme immunoassay detection of antigen-specific immunoglobulin g antibodies in longitudinal serum samples from patients with cryptosporidiosis. Clin Diagn Lab Immunol 8 :415–423.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Frost FJ, de la Cruz AA, Moss DM, Curry M, Calderon RL, 1998. Comparisons of ELISA and Western blot assays for detection of Cryptosporidium antibody. Epidemiol Infect. 121 :205–211.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Laxer MA, Alcantara AK, Javato-Laxer M, Menorca DM, Fernando MT, Ranoa CP, 1990. Immune response to cryptosporidiosis in Philippine children. Am J Trop Med Hyg 42 :131–139.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Zu SX, Li JF, Barrett LJ, Fayer R, Shu SY, McAuliffe JF, Roche JK, Guerrant RL, 1994. Seroepidemiologic study of Cryptosporidium infection in children from rural communities of Anhui, China and Fortaleza, Brazil. Am J Trop Med Hyg 51 :1–10.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Ungar BL, Soave R, Fayer R, Nash TE, 1986. Enzyme immunoassay detection of immunoglobulin M and G antibodies to Cryptosporidium in immunocompetent and immunocompromised persons. J Infect Dis 153 :570–578.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Ungar BL, Gilman RH, Lanata CF, Perez-Schael I, 1988. Seroepidemiology of Cryptosporidium infection in two Latin American populations. J Infect Dis 157 :551–556.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Janoff EN, Mead PS, Mead JR, Echeverria P, Bodhidatta L, Bhaibulaya M, Sterling CR, Taylor DN, 1990. Endemic Cryptosporidium and Giardia lamblia infections in a Thai orphanage. Am J Trop Med Hyg 43 :248–256.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Robin G, Fraser D, Orr N, Sela T, Slepon R, Ambar R, Dagan R, Le Blancq S, Deckelbaum RJ, Cohen D, 2001. Cryptosporidium infection in Bedouin infants assessed by prospective evaluation of anticryptosporidial antibodies and stool examination. Am J Epidemiol 153 :194–201.

    • PubMed
    • Search Google Scholar
    • Export Citation
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