Brief Report Indian Pediatrics 1999; 36:180-183 |
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Prevalence of Cryptosporidium Associated Diarrhea in a Community |
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T.B. Singh* S.P. Singh**
From the Department of Microbiology, Pediatrics* and Preventive and Social
Medicine**, Institute
Manuscript received: March 9,1998;
Initial review completed:
June
14, 1998;
Cryptosporidium, a protozoal parasite has been found world wide. causing. diarrhea in immunocompetent as well as immunocompromized individuals(1). About 80% diarrhea in children is infective in nature. In under-developed tropical countries, contribution of intestinal parasites in causation of diarrhea is reported to be considerably high(2). Of them, cryptosporidiosis in India, has been reported from north(3), south(4), east(5) and west(6) with the prevalence rate of 4.3, 13.0, 5.5 and 5.6%, respectively. Almost all the studies are hospital based and no report on cryptosporidium related diarrhea is available from the eastern part of northern India. The present study, therefore, was planned to study the role of Cryptosporidium in the etiology of childhood diarrhea in a semi-urban slum (Sunderpur) of Varanasi.Subjects and Methods This study was conducted in semi-urban slum (Sunderpur) of Varanasi for a period of one year. This community comprised 560 households with a total population of 3450, the average family size was 6.2 persons per family and the number of under five children was 549 (15.9%). Daily home visits were made to identify children experiencing diarrhea. Unmatched healthy controls were selected from the neigh- bor. Stool specimens were collected in a sterile container using morning visits (between 7.00 a.m. and 9.00 a.m.) to the families under the supervision of a resident doctor. Each child was visited at an interval of 4 months. Diarrhea was defined as per the definition of World Health Organization(7). Processing of Specimen The stool samples from 607 diarrheal and 529 non diarrheal children were examined following the methodology recommended by WHO(8) for viruses, bacteria and parasites. Cryptosporidium was detected by Safranine-methylene blue stain. In brief, 2 slades were prepared, one directly without concentration and other after formal ether concentration. The smears were dried in air and then fixed by acid alcohol (3% Hydrochloric acid in ethanol) for 3-5 min. Aqueous 1% Safranine was poured on slide with gentle heating from below until steam appeared which was kept for I min. After washing, counter staining was done with methylene blue for 30 seconds. Slides were then examined for oocyst which appears bright orange usually with clear halo. Other viral and bacterial pathogens were detected by the methodology described in World Health Organization manual(8). Statistical Analysis The stool samples positive only for Cryptosporidium, i.e., not mixed with other diarrhegen/s were included in this study. The data were analyzed using SPSS computer package. The difference in the prevalence rate with respect to different variables were tested by using Chi-square test. Results Of the total 607 diarrheal stool specimens, Crypt9Sporidium could be detected in 23 (3.8%) which was significantly higher (p<0.01) than that detected in non-diarrheal children (1.3%, 7i529; Table 1). Amongst parasitic diarrheagens, it was the 3rd commonest in under five children preceded by Giardia lamblia (10.3%, 63/607) and Entamoeba histolytica (5.1 %, 31/607). Although, statistically insignificant, the most and least susceptible age groups were observed to be 49-60 months and 0-12 months, respectively with the corresponding prevalence rates of 3;6% and 1.0% (Table II). The most favorable season for the protozoa was observed to be rainy with the detection rate of 3.6% (16/451) followed by winter (2.8%,9/329) and summer (1.4%, 5/356). The difference in these pre- valence rates however, were insignificant (p >0.05). Fourteen of the 604 male (2.4%) and 16 of 532 female children (3.1%) were found to be positive for the Cryptosporidium. (p >0.05). Of the 30 Cryptosporidium positive stool samples, consistency wise each liquid and semisolid were 14 (46.7%) while only 2 (0.1 %) were solid. Majority (63.3%, 19/30) of the stool samples associated with Cryptosporodium were mucoid in nature and the rest (36.7%,11/30) were non-mucoid. None of the parasite positive stool samples detected positive for red or white blood corpuscles. The mean frequency in diarrheal children due to Cryptosporidium had been 4.2 with the range of 3-12 per day. Table I
TABLE II
The data in the present study indicates that Cryptosporidium associated diarrhea in the. study population is usually of mild to moderate severity, without features of dysentery and mostly semisolid or liquid in consistency. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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