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Molecular Detection of the Carriage Rate of Four Intestinal Protozoa with Real-Time Polymerase Chain Reaction: Possible Overdiagnosis of Entamoeba histolytica in Nigeria

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  • Institute of Medical Microbiology and Infectious Disease Epidemiology, Medical Faculty, University of Leipzig, Leipzig, Germany; Ebonyi State University, Abakaliki, Nigeria; Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital Copenhagen, Denmark; Department of International Health, Immunology, and Microbiology, University of Copenhagen, Denmark; Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark

Diarrhea remains the second largest killer of children worldwide, and Nigeria ranks number two on the list of global deaths attributable to diarrhea. Meanwhile, prevalence studies on potentially diarrheagenic protozoa in asymptomatic carriers using molecular detection methods remain scarce in sub-Saharan countries. To overcome sensitivity issues related to microscopic detection and identification of cysts in stool concentrates, real-time polymerase chain reaction (PCR) was used to analyze genomic DNAs extracted from stool samples from 199 healthy school children for Entamoeba histolytica, E. dispar, Giardia intestinalis, and Cryptosporidium. Questionnaires were administered for epidemiological data collection. E. histolytica was not detected in any of the samples, whereas Giardia (37.2%), E. dispar (18.6%), and Cryptosporidium (1%) were found. Most of the children sourced their drinking water from community wells (91%), while the majority disposed of feces in the bush (81.9%). Our study is the first to use real-time PCR to evaluate the epidemiology of E. histolytica, Giardia, and Cryptosporidium in Nigeria where previous studies using traditional diagnostic techniques have suggested higher and lower carriage rates of E. histolytica and Giardia, respectively. It is also the first study to accurately identify the prevalence of common potentially diarrheagenic protozoa in asymptomatic carriers in sub-Saharan Africa.

Author Notes

* Address correspondence to Michael A. Efunshile, Institute of Medical Microbiology and Infectious Disease Epidemiology, Faculty of Medicine, University of Leipzig, Liebigstraß 21, 04103 Leipzig, Germany. E-mail: drefunshile@yahoo.com

Authors' addresses: Michael A. Efunshile, Institute of Medical Microbiology and Infectious Disease Epidemiology, University of Leipzig, Leipzig, Germany, and Department of Medical Microbiology and Parasitology, Ebonyi State University, Abakaliki, Ebonyi, Nigeria, E-mail: drefunshile@yahoo.com. Bethrand A. F. Ngwu, Department of Medical Microbiology and Parasitology, Ebonyi State University, Abakaliki, Ebonyi, Nigeria, E-mail: bethfrancis5@yahoo.com. Jørgen A. L. Kurtzhals, Department of Clinical Microbiology, Centre for Medical Parasitology, Copenhagen University Hospital, Copenhagen, Denmark, and Department of International Health, Immunology, and Microbiology, University of Copenhagen, Copenhagen, Denmark, E-mail: joergen.kurtzhals@rh.regionh.dk. Sumrin Sahar, Department of Microbiology and Infection Control, Statens Serum Institute, Copenhagen, Denmark, E-mail: sumrinsahar@yahoo.com. Brigitte König, Institute of Medical Microbiology and Infectious Disease Epidemiology, University of Leipzig, Leipzig, Germany, E-mail: brigitte.koenig@medizin.uni-leipzig.de. Christen R. Stensvold, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark, E-mail: run@ssi.dk.

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