• 1.

    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: 707713.

    • Search Google Scholar
    • Export Citation
  • 2.

    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: 710715.

    • Search Google Scholar
    • Export Citation
  • 3.

    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: 94101.

    • Search Google Scholar
    • Export Citation
  • 4.

    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: 156163.

    • Search Google Scholar
    • Export Citation
  • 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: 497506.

    • Search Google Scholar
    • Export Citation
  • 6.

    Agnew DG, Lima AA, Newman RD, Wuhib T, Moore RD, Guerrant RL, Sears CL, 1998. Cryptosporidiosis in northeastern Brazilian children: association with increased diarrhea morbidity. J Infect Dis 177: 754760.

    • Search Google Scholar
    • Export Citation
  • 7.

    Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM, 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564571.

    • Search Google Scholar
    • Export Citation
  • 8.

    Kaur R, Rawat D, Kakkar M, Uppal B, Sharma VK, 2002. Intestinal parasites in children with diarrhea in Delhi, India. Southeast Asian J Trop Med Public Health 33: 725729.

    • Search Google Scholar
    • Export Citation
  • 9.

    Ballal M, Shivananda PG, 2002. Rotavirus and enteric pathogens in infantile diarrhoea in Manipal, south India. Indian J Pediatr 69: 393396.

    • Search Google Scholar
    • Export Citation
  • 10.

    Shetty M, Brown TA, Kotian M, Shivananda PG, 1995. Viral diarrhoea in a rural coastal region of Karnataka India. J Trop Pediatr 41: 301303.

  • 11.

    Jindal N, Arora R, Bhushan B, Arora S, 1995. A study of infective aetiology of chronic diarrhoea in children in Amritsar. J Indian Med Assoc 93: 169170.

    • Search Google Scholar
    • Export Citation
  • 12.

    Das P Roy SS, MitraDhar K, Dutta P, Bhattacharya MK, Sen A, Ganguly S, Bhattacharya SK, Lal AA, Xiao L, 2006. Molecular characterization of Cryptosporidium spp. in children in Kolkata, India. J Clin Microbiol 44: 42464249.

    • Search Google Scholar
    • Export Citation
  • 13.

    Mathan MM, Venkatesan S, George R, Mathew M, Mathan VI, 1985. Cryptosporidium and diarrhoea in southern Indian children. Lancet 2: 11721175.

  • 14.

    Ajjampur SS, Gladstone BP, Selvapandian D, Muliyil JP, Ward H, Kang G, 2007. Molecular and spatial epidemiology of cryptosporidiosis in children in a semiurban community in south India. J Clin Microbiol 45: 915920.

    • Search Google Scholar
    • Export Citation
  • 15.

    Ajjampur SS, Rajendran P, Ramani S, Banerjee I, Monica B, Sankaran P, Rosario V, Arumugam R, Sarkar R, Ward H, Kang G, 2008. Closing the diarrhoea diagnostic gap in Indian children by the application of molecular techniques. J Med Microbiol 57: 13641368.

    • Search Google Scholar
    • Export Citation
  • 16.

    Ajjampur SS, Liakath FB, Kannan A, Rajendren P, Sarkar R, Moses PD, Simon A, Agarwal I, Mathew A, O'Connor R, Ward H, Kang G, 2010. Multisite study of cryptosporidiosis in children with diarrhea in India. J Clin Microbiol 48: 20752081.

    • Search Google Scholar
    • Export Citation
  • 17.

    Banerjee I, Ramani S, Primrose B, Moses P, Iturriza-Gomara M, Gray JJ, Jaffar S, Monica B, Muliyil JP, Brown DW, Estes MK, Kang G, 2006. Comparative study of the epidemiology of rotavirus in children from a community-based birth cohort and a hospital in south India. J Clin Microbiol 44: 24682474.

    • Search Google Scholar
    • Export Citation
  • 18.

    Ruuska T, Vesikari T, 1990. Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes. Scand J Infect Dis 22: 259267.

    • Search Google Scholar
    • Export Citation
  • 19.

    World Health Organization HO, 2006. WHO Child Growth Standards: Methods and Development: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index for Age. Geneva: World Health Organization.

    • Search Google Scholar
    • Export Citation
  • 20.

    Xiao L, Escalante L, Yang C, Sulaiman I, Escalante AA, Montali RJ, Fayer R, Lal AA, 1999. Phylogenetic analysis of Cryptosporidium parasites based on the small-subunit rRNA gene locus. Appl Environ Microbiol 65: 15781583.

    • Search Google Scholar
    • Export Citation
  • 21.

    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: 492497.

    • Search Google Scholar
    • Export Citation
  • 22.

    Leav BA, Mackay MR, Anyanwu A, O'Connor RM, Cevallos AM, Kindra G, Rollins NC, Bennish ML, Nelson RG, Ward HD, 2002. Analysis of sequence diversity at the highly polymorphic Cpgp40/15 locus among Cryptosporidium isolates from human immunodeficiency virus-infected children in South Africa. Infect Immun 70: 38813890.

    • Search Google Scholar
    • Export Citation
  • 23.

    Vidal M, Kruger E, Duran C, Lagos R, Levine M, Prado V, Toro C, Vidal R, 2005. Single multiplex PCR assay to identify simultaneously the six categories of diarrheagenic Escherichia coli associated with enteric infections. J Clin Microbiol 43: 53625365.

    • Search Google Scholar
    • Export Citation
  • 24.

    Monica B, Ramani S, Banerjee I, Primrose B, Iturriza-Gomara M, Gallimore CI, Brown DW, Moses PD, Gray JJ, Kang G, 2007. Human caliciviruses in symptomatic and asymptomatic infections in children in Vellore, south India. J Med Virol 79: 544551.

    • Search Google Scholar
    • Export Citation
  • 25.

    Phan TG, Nguyen TA, Yan H, Yagyu F, Kozlov V, Kozlov A, Okitsu S, Muller WE, Ushuijma H, 2005. Development of a novel protocol for RT-multiplex PCR to detect diarrheal viruses among infants and children with acute gastroenteritis in Eastern Russia. Clin Lab 51: 429435.

    • Search Google Scholar
    • Export Citation
  • 26.

    Gladstone BP, Muliyil JP, Jaffar S, Wheeler JG, Le Fevre A, Iturriza-Gomara M, Gray JJ, Bose A, Estes MK, Brown DW, Kang G, 2008. Infant morbidity in an Indian slum birth cohort. Arch Dis Child 93: 479484.

    • Search Google Scholar
    • Export Citation
  • 27.

    Bern C, Ortega Y, Checkley W, Roberts JM, Lescano AG, Cabrera L, Verastegui M, Black RE, Sterling C, Gilman RH, 2002. Epidemiologic differences between cyclosporiasis and cryptosporidiosis in Peruvian children. Emerg Infect Dis 8: 581585.

    • Search Google Scholar
    • Export Citation
  • 28.

    Fraser D, Dagan R, Naggan L, Greene V, El-On J, Abu-Rbiah Y, Deckelbaum RJ, 1997. Natural history of Giardia lamblia and Cryptosporidium infections in a cohort of Israeli Bedouin infants: a study of a population in transition. Am J Trop Med Hyg 57: 544549.

    • Search Google Scholar
    • Export Citation
  • 29.

    Cama VA, Bern C, Roberts J, Cabrera L, Sterling CR, Ortega Y, Gilman RH, Xiao L, 2008. Cryptosporidium species and subtypes and clinical manifestations in children, Peru. Emerg Infect Dis 14: 15671574.

    • Search Google Scholar
    • Export Citation
  • 30.

    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: 167175.

    • Search Google Scholar
    • Export Citation
  • 31.

    Miller K, Duran-Pinales C, Cruz-Lopez A, Morales-Lechuga L, Taren D, Enriquez FJ, 1994. Cryptosporidium parvum in children with diarrhea in Mexico. Am J Trop Med Hyg 51: 322325.

    • Search Google Scholar
    • Export Citation
  • 32.

    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: 149152.

    • Search Google Scholar
    • Export Citation
  • 33.

    Le Blancq SMKN, Zamani F, Upton SJ, Wu TW, 1997. Ribosomal RNA gene organization in Cryptosporidium parvum. Mol Biochem Parasitol 90: 463478.

  • 34.

    Cevallos AM, Zhang X, Waldor MK, Jaison S, Zhou X, Tzipori S, Neutra MR, Ward HD, 2000. Molecular cloning and expression of a gene encoding Cryptosporidium parvum glycoproteins gp40 and gp15. Infect Immun 68: 41084116.

    • Search Google Scholar
    • Export Citation
  • 35.

    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: 378384.

    • Search Google Scholar
    • Export Citation
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Symptomatic and Asymptomatic Cryptosporidium Infections in Children in a Semi-Urban Slum Community in Southern India

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  • Departments of Gastrointestinal Sciences and Community Health, Christian Medical College, Vellore, India; Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
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Cryptosporidium is a leading cause of childhood diarrhea in developing countries. We investigated symptomatic and asymptomatic cryptosporidiosis in 20 children less than two years of age in a semi-urban slum in southern India. All surveillance (conducted every two weeks) and diarrheal samples from 20 children (n = 1,036) with cryptosporidial diarrhea previously identified by stool microscopy were tested by polymerase chain reaction–restriction fragment length polymorphism for species and subgenotype determination. Thirty-five episodes of cryptosporidiosis were identified in 20 children, of which 25 were diarrheal. Fifteen episodes were associated with prolonged oocyst shedding. Multiple episodes of cryptosporidiosis occurred in 40% of the children. Most infections were with C. hominis, subtype Ia. Children with multiple infections had significantly lower weight-for-age and height-for-age Z scores at 24 months but had scores comparable with children with a single episode by 36 months. Multiple symptomatic Cryptosporidium infections associated with prolonged oocyst shedding occur frequently in this disease-endemic area and may contribute to the long-term effects of cryptosporidiosis on physical growth in these children.

Author Notes

*Address correspondence to Gagandeep Kang, Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India. E-mail: gkang@cmcvellore.ac.in

Financial support: This study was supported by Fogarty International Research Cooperative Agreement R03TW2711 and Global Infectious Disease Training Grant D43TW007392, National Institutes of Health. Birth cohort studies were supported by Wellcome Trust Grant 063144.

Authors' addresses: Sitara S. R. Ajjampur, Rajiv Sarkar, Premi Sankaran, Arun Kannan, Vipin K. Menon, and Gagandeep Kang, Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India, E-mails: sitararao@cmcvellore.ac.in, rsarkar@cmcvellore.ac.in, arunkannan@cmcvellore.ac.in, vipinmenon@cmcvellore.ac.in, and gkang@cmcvellore.ac.in. Jayaprakash Muliyil, Department of Community Health, Christian Medical College, Vellore, India, E-mail: jayaprakash@cmcvellore.ac. Honorine Ward, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, E-mail: hward@tuftsmedicalcenter.org.

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