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1
Cegielski JP, Ortega YR, McKee S, Madden JF, Gaido L, Schwartz DA, Manji K, Jorgensen AF, Miller SE, Pulipaka UP, Msengi AE, Mwakyusa DH, Sterling CR, Reller LB, 1999. Cryptosporidium, Enterocytozoon, and cyclospora infections in pediatric and adult patients with diarrhea in Tanzania. Clin Infect Dis 28 :314–321.
-
2
Gumbo T SS, Gangaidzo IT, Ortega Y, Sterling CR, Carville A, Tzipori S, Wiest PM, 1999. Intestinal parasites in patients with diarrhea and human immunodeficiency virus infection in Zimbabwe. AIDS 13 :819–821.
-
3
Maggi P, Larocca A, Quarto M, Serio G, Brandonisio O, Angarano G, 2000. Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1. Eur J Clin Microbiol Infect Dis 19 :213–217.
-
4
Weber R, Sauer B, Luthy R, 1993. D N. Intestinal coinfection with Enterocytozoon bieneusi and Cryptosporidium in a human immunodeficiency virus-infected child with chronic diarrhoea. Clin Infect Dis 17 :480–483.
-
5
Griffiths JK, 1988. Human-cryptosporidiosis: epidemiology, transmission, clinical disease, treatment and diagnosis. Advances in Parasitology. London: Academic Press, 38–85.
-
6
Guerrant R, 1997. Cryptosporidiosis: an emerging, highly infectious threat. Emerg Infect Dis 3 :551–557.
-
7
Desportes I, Le Charpentier Y, Galian A, Bernard F, Cochand-Priollet B, Lavergne A, Ravisse P, Modigliani R, 1985. Occurrence of a new microsporidan: Enterocytozoon bieneusi n.g., n. sp., in the enterocytes of a human patient with AIDS. J Protozool 32 :250–254.
-
8
Fisseha B, Petros B, Wolde MT, 1998.Cryptosporidium and other parasites in Ethiopian AIDS patients with chronic diarrhoea. East Afr Med J 75 :100–101.
-
9
Adjei A, Lartey M, Adiku TK, Rodrigues O, Renner L, Sifah E, Mensah JD, Akanmori B, Otchere J, Bentum BK, Bosompem KM, 2003. Cryptosporidium oocysts in Ghanaian AIDS patients with diarrhoea. E Afr Med J 80 :369–372.
-
10
Lebbad M, Norrgren H, Naucier A, Dias F, Andersson S, Linder E, 2001. Intestinal parasites in HIV-2 associated AIDS cases with chronic diarrhoea in Guinea-Bissau. Acta Trop 80 :45–49.
-
11
Assefa T, Mohammed H, Abebe A, Abebe S, Tafesse B, 1996. Cryptosporidiosis in children seen at the children’s clinic of Yekatit 12 Hospital, Addis Ababa. Ethiop Med J 34 :43–45.
-
12
Hojlyng N, Molbak K, Jepsen S, 1986. Cryptosporidium spp., a frequent cause of diarrhea in Liberian children. J Clin Microbiol 23 :1109–1113.
-
13
Perch M, Sodemann M, Jacobsen MS, Valentiner-Branth P, Steinsla 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.
-
14
Walters IN, Miller NM, van den Ende J, Dees GC, Taylor LA, Taynton LF, Bennett KJ, 1988. Outbreak of cryptosporidiosis among young children attending a day-care centre in Durban. S Afr Med J 74 :496–499.
-
15
Addy PAK, Aikins-Bekoe P, 1986. Cryptosporidiosis in diarrhoeal children in Kumasi, Ghana. Lancet i :735.
-
16
Molbak KAM, 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.
-
17
Wanachiwanawin D, Chokephaibulkit K, Lertlaituan P, Ongrotchanakun JKT, 2002. Intestinal microsporidiosis in HIV-infected children with diarrhoea. Southeast Asian J Trop Med Public Health 33 :241–245.
-
18
Tremoulet AH, Avila-Aguero ML, Paris MM, Canas-Coto A, Ulloa-Gutierrez R, Faingezicht I, 2004. Albendazole therapy for microsporidium diarrhea in immunocompetent Costa Rican children. Pediatr Infect Dis J 23 :915–918.
-
19
Coyle CM, Kotler DP, Noyer C, Orenstein JM, Tanowitz HB, Weiss LM, 1996. Prevalence of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon (Septata) intestinalis among patients with AIDS-related diarrhea: determination by polymerase chain reaction to the microsporidian small-subunit rRNA gene. Clin Infect Dis 23 :1002–1006.
-
20
Lambl BB, Pleskow D, Wanke CA, 1996. Malabsorption and wasting in AIDS patients with microsporidia and pathogen-negative diarrhea. AIDS 10 :739–744.
-
21
van Gool T, Nathoo KJ, Kiire CF, Dankert J, Mason PR, 1995. High prevalence of Enterocytozoon bieneusi infections among HIV-positive individuals with persistent diarrhoea in Harare, Zimbabwe. Trans R Soc Trop Med Hyg 89 :478–480.
-
22
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.
-
23
Tumwine JK, Kekitiinwa A, Nabukeera N, Akiyoshi D, Buckholt M, Tzipori S, 2002. Enterocytozoon bieneusi among children with diarrhea attending Mulago Hospital in Uganda. Am J Trop Med Hyg 67 :299–303.
-
24
Kish L, 1965. Survey Sampling. New York: John Wiley & Sons.
-
25
Brasil PLD, Paiva DD, Lobo MSC, Sodre FC, Silva SP, Villela EV, Silva EJ, Peralta JM, Morgado M, Moura H, 2000. Clinical and diagnostic features of intestinal microsporidiosis in HIV infected patients with chronic diarrhoea in Rio de Janeiro, Brazil. Rev Inst Med Trop S Paolo 42 :299–304.
-
26
Akiyoshi DE, Mor S, Tzipori S, 2003. Rapid displacement of Cryptosporidium parvum type 1 by type 2 in mixed infections in piglets. Infect Immun 71 :5765–5771.
-
27
Fox LM, Saravolatz LD, 2005. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis 40 :1173–1180.
-
28
Didier ES, 2005. Microsporidiosis: an emerging and opportunistic infection in humans and animals. Acta Trop 94 :61–76.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 27 | 27 | 9 |
| Full Text Views | 298 | 88 | 0 |
| PDF Downloads | 117 | 29 | 0 |
CRYPTOSPORIDIOSIS AND MICROSPORIDIOSIS IN UGANDAN CHILDREN WITH PERSISTENT DIARRHEA WITH AND WITHOUT CONCURRENT INFECTION WITH THE HUMAN IMMUNODEFICIENCY VIRUS
JAMES K. TUMWINE
JAMES K. TUMWINE
Department of Paediatrics and Child Health, Mulago Hospital, Makerere University Medical School, Kampala, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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ADDY KEKITIINWA
ADDY KEKITIINWA
Department of Paediatrics and Child Health, Mulago Hospital, Makerere University Medical School, Kampala, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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SABRINA BAKEERA-KITAKA
SABRINA BAKEERA-KITAKA
Department of Paediatrics and Child Health, Mulago Hospital, Makerere University Medical School, Kampala, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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GRACE NDEEZI
GRACE NDEEZI
Department of Paediatrics and Child Health, Mulago Hospital, Makerere University Medical School, Kampala, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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ROBERT DOWNING
ROBERT DOWNING
Department of Paediatrics and Child Health, Mulago Hospital, Makerere University Medical School, Kampala, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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XIAOCHUAN FENG
XIAOCHUAN FENG
Department of Paediatrics and Child Health, Mulago Hospital, Makerere University Medical School, Kampala, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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DONNA E. AKIYOSHI
DONNA E. AKIYOSHI
Department of Paediatrics and Child Health, Mulago Hospital, Makerere University Medical School, Kampala, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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SAUL TZIPORI
SAUL TZIPORI
Department of Paediatrics and Child Health, Mulago Hospital, Makerere University Medical School, Kampala, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; Division of Infectious Diseases, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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Cryptosporidium spp. and Enterocytozoon bieneusi are enteric pathogens that have emerged as significant causes of persistent diarrhea (PD) in immunologically compromised individuals particularly in association with HIV/AIDS. We conducted a cross-sectional study on the clinical epidemiology of E. bieneusi and Cryptosporidium in children with PD, with and without HIV/AIDS, attending Uganda’s Mulago National Referral Hospital. Two hundred forty-three children aged < 60 months, admitted between November 2002 and May 2003 with PD (> 14 days), were analyzed for HIV status and CD4 lymphocyte counts, and stools were screened for the presence of E. bieneusi and Cryptosporidium by microscopy and positive samples genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Eighty (32.9%) of the children were excreting E. bieneusi, and 76 (31.3%) were excreting Cryptosporidium. Ninety-one of the 243 children had HIV, of who 70 (76.9%) had E. bieneusi, versus 10 (6.6%) of the 152 without (odds ratio = 47.33; 95% CI = 19.88 to 115.97), while 67 (73.6%) had Cryptosporidium, versus 9 (5.9%) without (odds ratio = 44.36; 95% CI = 18.39 to 110.40). Children with counts < 25% CD4 cells were more likely to have either E. bieneusi (odds ratio = 7.42; 95% CI = 3.77 to 14.69) or Cryptosporidium (odds ratio = 6.45; 95% CI = 3.28 to 12.76) than those with higher CD4 percentages. However, only HIV status was independently associated with either Cryptosporidium or E. bieneusi. Among the 243 children with PD, 67 (27.8%) were infected with both enteric pathogens, with HIV being the only independent predictor of coinfection. Finally, some 81% of HIV-infected children with PD excreted one or both organisms, compared with only 10% of children with PD testing negative for HIV. Seventy-four percent of isolates were C. hominis, the anthroponotic species, 17% were C. parvum, the zoonotic species, and 8% were a mixture of the two or others.
Author Notes
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Reference Manager
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-
1
Cegielski JP, Ortega YR, McKee S, Madden JF, Gaido L, Schwartz DA, Manji K, Jorgensen AF, Miller SE, Pulipaka UP, Msengi AE, Mwakyusa DH, Sterling CR, Reller LB, 1999. Cryptosporidium, Enterocytozoon, and cyclospora infections in pediatric and adult patients with diarrhea in Tanzania. Clin Infect Dis 28 :314–321.
-
2
Gumbo T SS, Gangaidzo IT, Ortega Y, Sterling CR, Carville A, Tzipori S, Wiest PM, 1999. Intestinal parasites in patients with diarrhea and human immunodeficiency virus infection in Zimbabwe. AIDS 13 :819–821.
-
3
Maggi P, Larocca A, Quarto M, Serio G, Brandonisio O, Angarano G, 2000. Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1. Eur J Clin Microbiol Infect Dis 19 :213–217.
-
4
Weber R, Sauer B, Luthy R, 1993. D N. Intestinal coinfection with Enterocytozoon bieneusi and Cryptosporidium in a human immunodeficiency virus-infected child with chronic diarrhoea. Clin Infect Dis 17 :480–483.
-
5
Griffiths JK, 1988. Human-cryptosporidiosis: epidemiology, transmission, clinical disease, treatment and diagnosis. Advances in Parasitology. London: Academic Press, 38–85.
-
6
Guerrant R, 1997. Cryptosporidiosis: an emerging, highly infectious threat. Emerg Infect Dis 3 :551–557.
-
7
Desportes I, Le Charpentier Y, Galian A, Bernard F, Cochand-Priollet B, Lavergne A, Ravisse P, Modigliani R, 1985. Occurrence of a new microsporidan: Enterocytozoon bieneusi n.g., n. sp., in the enterocytes of a human patient with AIDS. J Protozool 32 :250–254.
-
8
Fisseha B, Petros B, Wolde MT, 1998.Cryptosporidium and other parasites in Ethiopian AIDS patients with chronic diarrhoea. East Afr Med J 75 :100–101.
-
9
Adjei A, Lartey M, Adiku TK, Rodrigues O, Renner L, Sifah E, Mensah JD, Akanmori B, Otchere J, Bentum BK, Bosompem KM, 2003. Cryptosporidium oocysts in Ghanaian AIDS patients with diarrhoea. E Afr Med J 80 :369–372.
-
10
Lebbad M, Norrgren H, Naucier A, Dias F, Andersson S, Linder E, 2001. Intestinal parasites in HIV-2 associated AIDS cases with chronic diarrhoea in Guinea-Bissau. Acta Trop 80 :45–49.
-
11
Assefa T, Mohammed H, Abebe A, Abebe S, Tafesse B, 1996. Cryptosporidiosis in children seen at the children’s clinic of Yekatit 12 Hospital, Addis Ababa. Ethiop Med J 34 :43–45.
-
12
Hojlyng N, Molbak K, Jepsen S, 1986. Cryptosporidium spp., a frequent cause of diarrhea in Liberian children. J Clin Microbiol 23 :1109–1113.
-
13
Perch M, Sodemann M, Jacobsen MS, Valentiner-Branth P, Steinsla 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.
-
14
Walters IN, Miller NM, van den Ende J, Dees GC, Taylor LA, Taynton LF, Bennett KJ, 1988. Outbreak of cryptosporidiosis among young children attending a day-care centre in Durban. S Afr Med J 74 :496–499.
-
15
Addy PAK, Aikins-Bekoe P, 1986. Cryptosporidiosis in diarrhoeal children in Kumasi, Ghana. Lancet i :735.
-
16
Molbak KAM, 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.
-
17
Wanachiwanawin D, Chokephaibulkit K, Lertlaituan P, Ongrotchanakun JKT, 2002. Intestinal microsporidiosis in HIV-infected children with diarrhoea. Southeast Asian J Trop Med Public Health 33 :241–245.
-
18
Tremoulet AH, Avila-Aguero ML, Paris MM, Canas-Coto A, Ulloa-Gutierrez R, Faingezicht I, 2004. Albendazole therapy for microsporidium diarrhea in immunocompetent Costa Rican children. Pediatr Infect Dis J 23 :915–918.
-
19
Coyle CM, Kotler DP, Noyer C, Orenstein JM, Tanowitz HB, Weiss LM, 1996. Prevalence of microsporidiosis due to Enterocytozoon bieneusi and Encephalitozoon (Septata) intestinalis among patients with AIDS-related diarrhea: determination by polymerase chain reaction to the microsporidian small-subunit rRNA gene. Clin Infect Dis 23 :1002–1006.
-
20
Lambl BB, Pleskow D, Wanke CA, 1996. Malabsorption and wasting in AIDS patients with microsporidia and pathogen-negative diarrhea. AIDS 10 :739–744.
-
21
van Gool T, Nathoo KJ, Kiire CF, Dankert J, Mason PR, 1995. High prevalence of Enterocytozoon bieneusi infections among HIV-positive individuals with persistent diarrhoea in Harare, Zimbabwe. Trans R Soc Trop Med Hyg 89 :478–480.
-
22
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.
-
23
Tumwine JK, Kekitiinwa A, Nabukeera N, Akiyoshi D, Buckholt M, Tzipori S, 2002. Enterocytozoon bieneusi among children with diarrhea attending Mulago Hospital in Uganda. Am J Trop Med Hyg 67 :299–303.
-
24
Kish L, 1965. Survey Sampling. New York: John Wiley & Sons.
-
25
Brasil PLD, Paiva DD, Lobo MSC, Sodre FC, Silva SP, Villela EV, Silva EJ, Peralta JM, Morgado M, Moura H, 2000. Clinical and diagnostic features of intestinal microsporidiosis in HIV infected patients with chronic diarrhoea in Rio de Janeiro, Brazil. Rev Inst Med Trop S Paolo 42 :299–304.
-
26
Akiyoshi DE, Mor S, Tzipori S, 2003. Rapid displacement of Cryptosporidium parvum type 1 by type 2 in mixed infections in piglets. Infect Immun 71 :5765–5771.
-
27
Fox LM, Saravolatz LD, 2005. Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis 40 :1173–1180.
-
28
Didier ES, 2005. Microsporidiosis: an emerging and opportunistic infection in humans and animals. Acta Trop 94 :61–76.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 27 | 27 | 9 |
| Full Text Views | 298 | 88 | 0 |
| PDF Downloads | 117 | 29 | 0 |