Vitaliano Cama

Cryptosporidium Species and Subtypes and Clinical Manifestations in Children, Peru

One-sentence summary for table of contents: Different genotypes and subtypes are linked to different clinical manifestations.

Differences in clinical manifestations among Cryptosporidium species and subtypes in HIV-infected persons

We performed a cross-sectional study to determine the epidemiology of Cryptosporidium in human immunodeficiency virus (HIV)-infected persons at 3 diagnostic levels: microscopy, genotypes of Cryptosporidium, and subtype families of C. hominis and C. parvum. The study enrolled 2,490 HIV-infected persons in Lima, Peru, and 230 were microscopy positive for Cryptosporidium infection. Specimens from 193 participants were available for genotyping. They had C. hominis (141 persons), C. parvum (22 persons), C. meleagridis (17 persons), C. canis (6 persons), C. felis (6 persons), and C. suis (1 person) infection. Although microscopy results showed that Cryptosporidium infections were associated with diarrhea, only infections with C. canis, C. felis, and subtype family Id of C. hominis were associated with diarrhea, and infection with C. parvum was associated with chronic diarrhea and vomiting. These results demonstrate that different Cryptosporidium genotypes and subtype families are linked to different clinical manifestations.

Cryptosporidium Species and Genotypes in HIV-Positive Patients in Lima, Peru

ABSTRACT: Cryptosporidium parasites from a cross‐sectional study conducted in two national hospitals in Lima, Peru were genetically characterized to deteimine the diversity of Cryptosporidium spp. in HIV‐positive people. A total of 2,672 patients participated in this study and provided 13,937 specimens. Cryptosporidium oocysts were detected by microscopy in 354 (13.3%) of the patients. Analysis of 951 Cryptosporidium‐ positive specimens from 300 patients using a small subunit rRNA‐based PCR‐RFLP tool identified 6 genotypes; Cryptosporidium hominis was the species most frequently detected (67.5%), followed by C. meleagridis (12.6%) and C. parvum (11.3%). Cryptosporidium canis (4.0%), C. felis (3.3%), and Cryptosporidium pig genotype (0.5%) were also found. These findings indicate that C. hominis is the predominant species in Peruvian HIV‐positive persons, and that zoonotic Cryptosporidium spp. account for about 30% of cryptosporidiosis in these patients.

Genotype and subtype analyses of Cryptosporidium isolates from dairy calves and humans in Ontario

To assess the importance of dairy cattle as a source of human Cryptosporidium infections in Ontario, Canada, 44 Cryptosporidium isolates from neonatal dairy calves and 11 from sporadic human cases of cryptosporidiosis in the province were genotyped by PCR-RFLP analyses of the Cryptosporidium oocyst wall protein (COWP) and 18S rRNA genes. Isolates were also subtyped by sequence analysis of the 60-kDa glycoprotein (GP60) gene. All bovine isolates successfully subtyped belonged to Cryptosporidium parvum subtype family (allele) IIa. Seven subtypes of this family were identified among the bovine isolates. Four human isolates were Cryptosporidium hominis, of alleles Ia, Id, and Ie. Of the remaining seven human specimens, four were C. parvum allele IIa, two were C. parvum of an undetermined subtype, and one was identified as Cryptosporidium cervine genotype. Three of the C. parvum isolates from humans were the same subtypes as isolates from the calves. These findings suggest that cattle and other ruminants may be a source of sporadic human infections in Ontario. This is the first published description of Cryptosporidium genotypes and subtypes in Ontario, and is the second published report of human infection with Cryptosporidium cervine genotype.

Giardiasis in dogs and cats: update on epidemiology and public health significance

Molecular data have defined seven genetic Assemblages of Giardia duodenalis, named A-G. Humans are infected with Assemblages A and B, dogs primarily with C and D, and cats with F. Assemblage A has been subclassified into subtypes A-I to A-IV: A-I has been reported in humans and animals, A-II in humans, and A-III and IV exclusively in animals. Assemblage B has broad host specificity infecting humans and animals. Recently, small numbers of dogs and cats have been reported to also carry Assemblages A-I or B. Because these genotypes are found primarily in humans, and no comprehensive studies to address zoonotic transmission of G. duodenalis are yet available, the potential role of dogs and cats cannot be conclusively excluded.

Multiple Norovirus Infections in a Birth Cohort in a Peruvian Periurban Community

Serial norovirus infections with multiple genotypes were found among a Peruvian birth cohort early in infancy. Protection against the subsequent infection was genotype specific, suggesting that norovirus vaccines may need to target multiple genotypes.

The Epidemiology of Intestinal Microsporidiosis in Patients with HIV/AIDS in Lima, Peru

We studied microsporidiosis in human immunodeficiency virus-positive patients in 2 Lima hospitals. Of 2652 patients, 66% were male, 6% received antiretroviral therapy (ART), and the median CD4 lymphocyte count was 131 cells/microL. Sixty-seven patients (3%) had microsporidiosis; stool specimens from 56 were identified as having Enterocytozoon bieneusi of 10 different genotypes. The 2 most common genotypes, Peru-1 and Peru-2, were not associated with significant increases in chronic diarrhea; other genotypes were associated with a 4-fold increased risk. Risk factors for E. bieneusi infection segregated by genotype: contact with duck or chicken droppings and lack of running water, flush toilet, or garbage collection with genotype Peru-1 and watermelon consumption with other genotypes. Shortened survival was associated with low CD4 lymphocyte count (P<.0001), no ART (P<.0001), and cryptosporidiosis (P=.004) but not with microsporidiosis (P=.48). Our data suggest the possibility of zoonotic E. bieneusi transmission and an association with poor sanitary conditions.

Minimal zoonotic risk of cryptosporidiosis from pet dogs and cats.

The role of dogs and cats in human cryptosporidiosis has been the focus of much attention. Studies in which genotyping of Cryptospiridium oocysts in feces of dogs and cats have been successful and have demonstrated that most infections in these animals are caused by host-specific C. canis and C. felis, respectively. Most human cases of cryptosporidiosis are associated with C. hominis and C. parvum; C. canis and C. felis are responsible for only a small number of cases. Thus, molecular epidemiologic studies support the contention that the risk of zoonotic transmission of Cryptosporidium spp. from pet cats and dogs is low. Veterinarians can inform their clients of this minimal risk, but nevertheless advise them to minimize contact with pet cat and dog feces.

Mixed Cryptosporidium infections and HIV.

Mixed Cryptosporidium infections were detected in 7 of 21 patients with a diagnosis of rare Cryptosporidium canis or C. felis infections; 6 patients were infected with 2 Cryptosporidium spp. and 1 patient with 3 species. Mixed infections may occur more frequently than previously believed and should be considered when assessing cryptosporidiosis.

A Molecular Biologic Study of Enterocytozoon bieneusi in HIV-Infected Patients in Lima, Peru

ABSTRACT. A cross‐sectional study was conducted to examine the genotype distribution of Enterocytozoon bieneusi in HIV‐infected patients who visited two government hospitals in Lima, Peru from January 2000 through March 2003. Microsporidia were detected by microscopy in 105 (3.9%) of 2,672 patients. A total of 212 stool samples from 89 microsporidia‐positive patients were genotyped by sequence analysis of the internal transcribed spacer (ITS) region of the rRNA gene. A 392‐bp fragment containing the complete ITS region was amplified and sequenced. Multiple alignments and phylogenetic analysis of these ITS sequences identified 11 distinct genotypes of E. bieneusi (Peru‐1 to Peru‐11), 6 of which were new genotypes not reported before. The remaining 5 genotypes had nucleotide sequences identical to those previously reported in humans, cats, pigs, and wild mammals. All the 11 E. bieneusi‐genotypes identified are genetically related, and members of the group have been previously found in humans, domestic animals, and some wild mammals. Thus, there is a high genetic diversity of E. bieneusi in humans in Peru, and zoonotie transmission is possible if humans are in close contact with infected animals.