Symptomatic and Asymptomatic Cryptosporidium Infections in Children in a Semi-Urban Slum Community in Southern India

Sitara S. R. Ajjampur 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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Rajiv Sarkar 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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Premi Sankaran 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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Arun Kannan 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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Vipin K. Menon 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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Jayaprakash Muliyil 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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Honorine Ward 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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Gagandeep Kang 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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