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Brief Report

Indian Pediatrics 1999; 36:180-183 

Prevalence of Cryptosporidium Associated Diarrhea in a Community


Gopal Nath
T.B. Singh*
S.P. Singh**

From the Department of Microbiology, Pediatrics* and Preventive and Social Medicine**, Institute
 of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.

Reprint requests: Dr. Gopal Nath, Senior Lecturer,
. Department of Microbiology, Institute of
Medical Sciences, Banaras Hindu University, Varanasi 221005, India.

Manuscript received: March 9,1998; Initial review completed: June 14, 1998;
Revision accepted: October 8, 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 Crypto
sporodium 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

Outcome of Different Enteropathogen in Diarrheal and Non-diarrheal Children

Organism Diarrheal Non-diarrheal total
  No. % No. % No. %
A. lumbricoidis 116 18.3 141 26.7 257 22.6
Rotavirus 100 16.4 22 4.2 122 10.7
Enterotoxigenic E.coli 84 13.8 26 4.9 110 9.6
G.lamblia 93 10.3 30 5.6 93 8.2
EPEC 43 7.0 19 3.5 62 5.4
E. histolytica 31 5.1 12 2.3 43 3.8
C. jejuni 24 4.0 4 0.8 28 2.5
Cryptospridium 23 3.8* 7 1.3* 30 2.6
H.nana 23 3.8 9 1.7 32 2.8
Shigella spp. 22 3.6 26 3.0 38 3.3
V. fluvialis 12 19.0 0 0 12 1.0
Aeromonas spp 9 1.5 6 1.1 15 1.3
P. Shigelloides 3 0.5 2 0.4 5 0.4
V. Cholerae non 01 3 0.5 6 1.1 9 0.8
Salmonella spp 2 0.3 0 0 2 0.17
V mimicus 2 0.3 0 0 2 0.17

*P<0.01


Discussion

The reports, mostly hospital based, avail- able in India(5-9) have shown relatively higher prevalence rate (4.3-13%) than the present one (3.8%). Since this enteropathogen was observed to be the 3rd commonest parasite, it's significance in community as an etiological agent of diarrhea cannot be over- looked. In contrast to the reports(5) showing <2 years as the most susceptible age, we did not find any significant difference in the occurrence of the parasite in different age groups of under five children of the community. It will be interesting, to do the seroepidemiology of this pathogen in the community involving a wide age range.

Hot and humid rainy months have been reported to be the most favorable season(9) but no such seasonal variation could be observed in the present study. In a hospital based study we have found that rainy months were favorable for the pathogen (unpublished
data). The reasons for the varying observation in the community deserve exploration. As reported earlier(5,10), males and females appeared equally slisceptible to the protozoa.
 

TABLE II

 Age wise Distribution of Children Excreting Cryptosporidium

 

Age (mo)
 
Specimens
examined
 
 
Cryptosporidium
detected
No. %
0-12 298 3 1.0
13-24 292 10 3.4.
25-36 235 7 3.0
37-48 173 5 2.8
49-60 138 5 3.6
Total 1136 30 2.6


The differences were not statistically significant.

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.

 

 References


1. Guerrant RL. Cryptosporidiosis: An emerging, highly infectious threat. Emerg Infect Dis 1997; 31: 51-57.

2. Nath G, Chaudhury A, Shukla BN, Sanyal SC. Intestinal parasite among under five Children in .1 semi urban slum of northern. India. Indian J Med Microbiol 1995; 13: 196-199.

3. Uppal B, Natarajan R. Detection of cryptosporidium oocyst in acute diarrheal stools. Indian Pediatr 1991; 28: 917-920.

4. Mathan MM, Venkatesan S, George R, Mathew
M, Mathai VI. Cryptosporidium and diarrhea in southern Indian children. Lancet 1985; II: 1172-1175.

5. Das P, Sengupta K, Dutta P, Bhattacharya MK, Pal SC, Bhattacharya SK. Significance of cryptosporidium as an etiological agent in acute diarrhea in Calcutta. A hospital based study. J Trap Med Hyg 1993; 96: 124-127.

6. Saraswati K, Pandit PV, Deodhar LP, Bichile LS. Prevalence of cryptosporidiosis in Bombay. Indian J Med Res 1998; 87: 221-224.

7. World Health Organization. Persistent Diarrhoea in Children in Developing Countries. Re- port of WHO meeting, Geneva, World Health Organization, CDD/88, 1988.

8. World Health Organization. Manual for Laboratory Investigations of Acute Enteric Infection. Geneva, World Health Organization, CDD/88.3,1987.

9. Javier Enriquez F, Avila CR, Fgancio Sterling CR. Cryptosporidiosis in Mexican children AmJ Trop Med Res 1997; 56: 254-257.

10. Das P. Cryptosporidium related diarrhea. Indian J Med Res 1996; 104: 86-95.

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