<i>Cryptosporidium</i> diagnosis in different groups of children and characterization of parasite species

Pacheco, Flávia Thamiris Figueiredo; Freitas, Humberto Fonseca de; Silva, Renata Kelly Novais Rodrigues; Carvalho, Silvia Souza de; Martins, Adson Santos; Menezes, Joelma Figueiredo; Ribeiro, Tereza Cristina Medrado; Mattos, Ângela Peixoto de; Costa-Ribeiro Júnior, Hugo da; Pedreira, Joice Neves Reis; Soares, Neci Matos; Teixeira, Márcia Cristina Aquino

doi:10.1590/0037-8682-0041-2022

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Short Communication • Rev. Soc. Bras. Med. Trop. 55 • 2022 • https://doi.org/10.1590/0037-8682-0041-2022 copy

Cryptosporidium diagnosis in different groups of children and characterization of parasite species

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

Microscopy and enzyme-linked immunosorbent assay (ELISA) are routinely used for Cryptosporidium diagnosis, without differentiating the parasite species.

Methods:

Children’s feces were analyzed by modiﬁed Ziehl-Neelsen (mZN) and ELISA for Cryptosporidium diagnosis and by polymerase chain reaction-restriction fragment length polymorphism for species identification.

Results:

Cryptosporidium frequency was 2.6%. The sensitivity and specificity of ELISA were 85.7% and 99.7%, respectively, with excellent concordance with mZN (kappa=0.854). Parasite species were characterized as Cryptosporidium hominis (78.3%), Cryptosporidium felis (17.4%), and Cryptosporidium parvum (4.3%).

Conclusions:

Coproantigen ELISA is as efficient as mZN for Cryptosporidium diagnosis. Cryptosporidium genotyping suggests anthroponotic and zoonotic transmission to children.

Keywords:
Cryptosporidium; Diagnosis; Children; Genotyping

	Groups of children, N (%)
	Diarrhea	Malnourished	Cancer	HIV-seropositive	Daycare	Total
	171 (27.3)	88 (14.1)	79 (12.6)	30 (4.8)	258 (41.2)	626 (100.0)
Sex
Female	69 (40.4)	47 (53.4)	36 (45.6)	17 (56.7)	114 (44.2)	283 (45.2)
Male	102 (59.6)	41 (46.6)	43 (54.4)	13 (43.3)	144 (55.8)	343 (54.8)
Age (years)
0-5	153 (89.5)^a,b	81 (92.0)^a,b	54 (68.4)^a,b,c	11 (36.7)^a,b,c,d	258 (100)^c,d	557 (89.0)
5-10	18 (10.5)	7 (8.0)	25 (31.6)	19 (53.3)	0 (0.0)	69 (11.0)
Residence area
Urban/periurban	156 (91.2)^a,b	71 (80.7)^c	47 (59.5)^a,c,d	30 (100.0)^a,b,c,d	258 (100.0)^a,d	562 (89.8)
Rural	15 (8.8)	17 (19.3)	32 (40.5)	0 (0.0)	0 (0.0)	64 (10.2)
Highest education level of mother*
None	2 (1.2)	2 (2.3)	6 (7.6)	----	0 (0.0)	10 (1.7)
Elementary school	112 (65.5)^a,c	46 (52.2)^b,d	29 (36.7)^a,b	----	61 (23.6)^c,d	248 (41.6)
High school	51 (29.8)^a,d	38 (43.2)^b	43 (54.4)^c,d	----	191 (74.0)^a,b,c	323 (54.2)
College	6 (3.5)	2 (2.3)	1 (1.3)	----	6 (2.3)	15 (2.5)
Monthly income (MW)*
≤1 MW	110 (64.3)	68 (77.3)	67 (84.8)^a	----	169 (65.5)^a	414 (69.5)
>1≤2 MW	45 (26.3)	15 (17.0)	8 (10.1)	----	68 (26.4)	136 (22.8)
>2 MW	16 (9.4)	5 (5.7)	4 (5.1)	----	21 (8.1)	46 (7.7)
Access to sanitary conditions/pets
Piped water	165 (96.5)^a	80 (90.9)^b	53 (67.1)^a,b,c,d	30 (100.0)^c	249 (96.5)^d	577 (92.2)
Sewage system	146 (85.4)^a	59 (67.1)^b	38 (48.1)^a,c,d	30 (100.0)^c	234 (90.7)^d	507 (81.0)
Bathroom with sink	150 (87.7)^a	73 (83.0)^b	54 (68.4)^a,b,c,d	30 (100.0)^c	253 (98.1)^d	560 (89.5)
Contact with dogs and/or cats	58 (33.9)^a	25 (28.4)^b	52 (65.8)^ac	0 (0.0)	65 (25.2)^c	200 (31.9)
Cryptosporidium infection
	8 (4.7)^a	2 (2.3)	2 (2.5)	1 (3.3)	3 (1.2)^a	16 (2.6)

	Modiﬁed Ziehl-Neelsen			Sensitivity*	Specificity*	Kappa
ELISA	Positive	Negative	Total	(95% CI)	(95% CI)	(95% CI)
Positive	12	2	14	85.7%	99.7%	0.854
Negative	2	610	612
Total	14	612	626	(60.1-96.0%)	(98.8-99.9%)	(0.725-0.995)

Origin of samples	Samples	ELISA	Modiﬁed Ziehl-Neelsen	COWP	Cryptosporidium species	18S rDNA	Cryptosporidium species
Children with diarrhea	D1	-	+	+	C. hominis	+	C. hominis
	D2	+	+	+	C. hominis	+	C. hominis
	D3	+	+	+	C. hominis	+	C. hominis
	D4	+	+	+	C. hominis	+	C. felis*
	D5	+	+	+	C. hominis	+	C. felis*
	D6	+	+	+	C. hominis	+	C. hominis
	D7	+	+	+	C. hominis	+	C. hominis
	D8	+	-	+	C. hominis	+	C. hominis
Malnourished children	M1	+	+	+	C. hominis	+	C. hominis
	M2	-	+	+	C. hominis	-	NA
Children with cancer	C1	+	+	+	C. hominis	+	C. hominis
	C2	+	+	+	C. hominis	+	C. hominis
HIV-seropositive children	CH1	+	-	-	NA	-	NA
Daycare children	DC1	+	+	-	NA	+	C. felis*
	DC2	+	+	+	C. hominis	+	C. hominis
	DC3	+	+	+	C. hominis	+	C. hominis
	DC4	+	+	+	C. hominis	+	C. hominis
	DC5	+	+	+	C. hominis	+	C. hominis
Children from rural area	R1	+	+	+	C. hominis	+	C. hominis
	R2	+	+	+	C. hominis	+	C. hominis
	R3	+	-	+	C. hominis	+	C. hominis
	R4	+	+	-	NA	-	NA
	R5	+	+	+	C. parvum	+	C. parvum
HIV-seropositive adults	AH1	+	+	+	C. hominis	+	C. hominis
	AH2	+	+	-	NA	+	C. felis*

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[1] Corresponding author: Dr. Márcia Cristina Aquino Teixeira. e-mail:marciat@ufba.br