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CRYPTOSPORIDIOSIS: PREVALENCE, GENOTYPE ANALYSIS, AND SYMPTOMS ASSOCIATED WITH INFECTIONS IN CHILDREN IN KENYA

Cryptosporidium parasites are leading causes of enteric disease, especially in children. A prospective survey on the prevalence of cryptosporidiosis in children less than five years of age was undertaken at six microbiology laboratories in Kenya on fecal samples submitted for routine parasite and ova investigations. Analysis of 4,899 samples over a two-year study period showed an overall prevalence of cryptosporidiosis of 4% that was highest between November to February. Investigations on the nature of enteric diseases prompting ova and cyst examination requests showed 66.4% had acute diarrhea, 9% had persistent diarrhea, and 21% had recurrent diarrhea. The main symptoms were abdominal pain (51.1%), vomiting (51.6%), and abdominal swelling (11%). The prevalence of cryptosporidiosis was highest among children 13–24 months of age (5.2%) and least among those 48–60 months of age (2%). No significant differences were observed by sex but vomiting was slightly higher in males than in females (65% males and 52% females; P = 0.07). Cryptosporidiosis was significantly associated with persistent diarrhea (P = 0.0001, odds ratio [OR] = 2.193, 95% confidence interval [CI] = 1.463–3.29), vomiting (P = 0.0273, OR = 1.401, 95% CI = 1.04–1.893), and abdominal swelling (P = 0.0311, OR = 1.56, 95% CI = 1.04–2.34). Genotype analysis based on polymerase chain reaction–restriction fragment length polymorphism of the 18S rRNA gene fragment showed that 87% (153 of 175) of the Cryptosporidium isolates were C. hominis, 9% (15 of 175) were C. parvum, and remaining 4% were C. canis, C. felis, C. meleagridis, and C. muris. The most common protozoa in coinfected patients were Entamoeba histolytica/E. dispar, E. coli, and Giardia intestinalis (6%, 5%, and 2%, respectively). Our results show that Cryptosporidium is among the most common protozoan parasites in children with enteric diseases and that anthroponotic species are the leading cause of human cryptosporidiosis in Kenya, which suggests that human-to-human transmission is the main mode of spread.

Received January 13, 2006. Accepted for publication March 23, 2006.

Acknowledgments: We are indebted to Dr Lihua Xiao (CDC, Atlanta GA) for technical input and advice on the molecular genotyping. We are also grateful to the microbiology diagnostic teams at all our collaborating hospitals, and at the Center for Microbiology Research, including John Kiiru, Francis Ngugi, Jonathan Bett, the data management team, Doris Njomo, Mary Nderitu, and Anthony Isavwa for their dedicated work during the study.

Financial support: This study was supported by a Wellcome Trust Grant to the Kenya Medical Research Institute, through the University of Liverpool, under the Research Development Award for Tropical Diseases. The work has been published with the permission of Director of the Kenya Medical Research Institute.

^* Address correspondence to Wangeci Gatei, Department of Medical Microbiology and Genito-Urinary Medicine, University of Liverpool, Duncan Building, Eighth Floor, Daulby Street, Liverpool L69 3GA, United Kingdom. E-mail: wgatei{at}kemri.org

Authors’ addresses: Wangeci Gatei, Claire N. Wamae, Cecilia Mbae, Anthony Waruru, Erastus Mulinge, Tabitha Waithera, Simon M. Gatika, and Stanely K. Kamwati, Centre for Microbiology Research, Kenya Medical Research Institute, PO Box 19464, Nairobi, Nairobi. Gunturu Revathi, Kenyatta National Hospital, PO Box 20723, Nairobi, Kenya. Charles A. Hart, Department of Medical Microbiology and Genito-Urinary Medicine, University of Liverpool, Duncan Building, Eighth Floor, Daulby Street, Liverpool L69 3GA, United Kingdom, E-mail: C.A.Hart{at}liverpool.ac.uk.

Reprint requests: C. A. Hart, Department of Medical Microbiology and Genito-Urinary Medicine, University of Liverpool, Duncan Building, Eighth Floor, Daulby Street, Liverpool L69 3GA, United Kingdom, Telephone: 44-151-706-4381, Fax: 44-151-706-5805, E-mail: c.a.hart{at}Liverpool.ac.uk.

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