Tag Archive for Cryptosporidium

Chapter 2 – Detection of diarrhoea-causing protozoa in general practice patients in The Netherlands by multiplex real-time PCR.

Abstract
The diagnostic value of a multiplex real-time PCR for the detection of Entamoeba histolytica, Giardia lamblia and Cryptosporidium parvum/Cryptosporidium hominis was evaluated by comparing the PCR results obtained with those of routinely performed microscopy of faecal samples from patients consulting their general practitioner (GP) because of gastrointestinal complaints. Analysis of 722 faecal DNA samples revealed that the prevalence of G. lamblia was 9.3% according to PCR, as compared to 5.7% by microscopy. The number of infections detected was more than double in children of school age. Furthermore, G. lamblia infection was detected in 15 (6.6%) of 228 faecal samples submitted to the laboratory for bacterial culture only. C. parvum/C. hominis infections were not diagnosed by routine procedures, but DNA from these organisms was detected in 4.3% of 950 DNA samples. A strong association with age was noted, with Cryptosporidium being detected in 21.8% of 110 children aged <5 years. C. hominis was the most prevalent species. E. histolytica was not detected in this study population. Analysis of microscopy data revealed that the number of additional parasites missed by PCR was small. Overall, the study demonstrated that a multiplex real-time PCR approach is a feasible diagnostic alternative in the clinical laboratory for the detection of parasitic infections in patients consulting GPs because of gastrointestinal symptoms.

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R. ten Hove, T. Schuurman, M. Kooistra, L. Möller, L. van Lieshout and J. J. Verweij

Clinical Microbiology and Infection (2007), 13 (10): 1001-1007

Supraregional emergence of cryptosporidiosos.

As of yet unexplained supraregional emergence of cryptosporidiosos in the Netherlands
From: P.C. Wever, I.T.M.A. Overdevest, B. Mulder, T.G. Mank, M.H.A. Hermans, J. Roelfsema, J.G. Kusters, J.W. Dorigo-Zetsma, M. Deege and L.M. Kortbeek.

Nederlands Tijdschrift voor Medische Microbiologie. December 2012, nr. 4.

Cryptosporidiosis is a seasonal gastrointestinal illness caused by protozoa of the genus Cryptosporidium. From week 31 onwards an increase in the number of cryptosporidiosis cases was observed in the ‘s-Hertogenbosch area. In a 7-week period (weeks 31-37), 43 patients were identified with stools that were PCR positive for Cryptosporidium spp. (median Ct value 28.1, range 19.1-37.5). In 2011, 3 patients with positive stools were detected in the same period. Of the 43 patients, 63.4% were female.

Crypto

Although there were 6 groups of ≥2 patients with identical four digit postal codes, geographic clustering was not apparent. Stool diagnostics of 37 patients were requested by 30 family physicians and the remainder by hospital pediatricians. Significant co-infections were identified in 20.1% of patients (Giardia lamblia (6x), Campylobacter lari, Salmonella spp., human parechovirus/enterovirus). A recent visit abroad was listed for 14% of patients. Similar signals were subsequently received from Tilburg/Breda/Rossendaal (5.8% and 7.8% of stool samples Cryptosporidium positive in August and September 2011), Hilversum/Almere, Utrecht, Enschede, Groningen and Friesland. Ninety-one positive stools referred to the RIVM from ‘s-Hertogenbosch, Hilversum/Almere, Utrecht, Haarlem and Enschede were subtypable using GP60 analysis and identified as containing Cryptosporidium hominis IbA10G2 in 75 (82.4%) of cases. C. hominis exists only in human-to-human transmission cycle. As of yet, a cause of this increase has not been identified.

Note from Robert ten Hove

What is striking in this report is the distribution over the age-group. Such a distribution is typical for Giardia lamblia, indicating a child-parent mode of infection. This distribution, however, is normally not seen with Cryptosporidium.

Similar finding were reported in The Netherlands in 2005. That study showed 21.8% of all children with gastro-enteritis age <5 years to be infected with Cryptosporidium.

These outbreaks would not have been unearthed when laboratories were still using microscopy for stool examination. Perhaps, in 2019 another outbreak will emerge?